Tumour lysis syndrome: a rare side effect of imatinib therapy for GIST

Abstract

Tumour lysis syndrome (TLS) is a life-threatening complication wherein massive tumour cell lysis results in severe metabolic abnormalities. TLS generally follows chemotherapy of rapidly proliferating haematological malignancies; spontaneous TLS and TLS from treatment of solid tumours are infrequently reported. We present a rare case of TLS following treatment of a large gastrointestinal stromal tumour (GIST) in a 63- year-old man. Imatinib was started for tumour size reduction prior to surgical intervention and in 5 days the patient developed metabolic derangements consistent with TLS. Imatinib was held and fluids, allopurinol and rasburicase were started. All metabolic abnormalities resolved in 3 days. Imatinib was restarted, and he eventually underwent surgical intervention. This is the second case demonstrating successful reinitiation of imatinib following TLS when treating GIST. We highlight the importance of risk factor assessment and need for pre-emptive therapy to prevent TLS when using tyrosine kinase inhibitor therapy.

Factors Influencing the Steady-State Plasma Concentration of Imatinib Mesylate in Patients With Gastrointestinal Stromal Tumors and Chronic Myeloid Leukemia

“…PK variability, which is mainly caused by physiological, pathological, genetic, demographic, and environmental factors, manifests as a broad range of plasma trough levels (C min ) in patients receiving the same dosage, usually 400 mg/d of IM ( Widmer et al, 2014 ). The main side effects of IM in patients with GISTs, such as myelosuppression and periocular edema, have been observed in ∼50% of the patients ( Ondecker et al, 2018 ). Although most of these side effects have been classified as moderate, grade-1, or grade-2 adverse events, according to the Common Terminology Criteria for Adverse Events, the quality of life could be adversely affected to a significant degree by physical and psychosocial discomfort ( Abu-Amna et al, 2016 ).…”