Cancer treatment is potentially fatal

Standard chemotherapy (combination of 5-FU and irinotecan drugs) can produce such a rapid killing of cancer cells that it may induce acidosis, a life-threatening condition. Called "tumor lysis syndrome," this fatal complication is admission that first-line chemotherapy for cancers, like colon cancer, is potentially fatal within 72 hours of the first course of treatment. - Tumori 90: 514-16, Sept-Oct. 2004.

Tumori. 2004 Sep-Oct;90(5):514-6.
Rapid tumor lysis syndrome in a patient with metastatic colon cancer as a complication of treatment with 5-fluorouracil/leucoverin and irinotecan.
Oztop I, Demirkan B, Yaren A, Tarhan O, Sengul B, Ulukus C, Akin D, Sen M, Yilmaz U, Alakavuklar M.
Division of Hematology-Oncology, Department of Internal Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey. ilhan.oztop@deu.edu.tr

Tumor lysis syndrome is a potentially fatal complication of anti-cancer therapy that is usually seen in patients with bulky, rapidly proliferating, treatment-sensitive tumors such as hematological malignancies, but it rarely occurs in a variety of solid tumors such as colorectal carcinoma. Combination chemotherapy with infusional 5-fluorouracil/leucoverin and irinotecan has been recently accepted as the first treatment option for metastatic colorectal cancer. We present a case of tumor lysis syndrome in a patient with metastatic colon carcinoma that occurred 72 hrs after the initial course of a combination chemotherapy with irinotecan and 5-fluorouracil/leucoverin. Despite the immediate treatment with aggressive hydration by a sodium bicarbonate infusion, followed by forced diuresis and uricolytic therapy, he died of a sudden cardiac arrest complicated by acute renal failure. Our case indicates that administration of 5-fluorouracil/leucoverin and irinotecan for bulky tumors of colorectal origin with a rapid doubling time may induce an acute tumor lysis syndrome, which necessitates frequent laboratory monitoring and a close follow-up of the patient as well as prompt initiation of appropriate therapeutic measures.