Unexpected side effect in mCRC

A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy

Michela Quirino, Sabrina Rossi, Giovanni Schinzari, Michele Basso, Antonia Strippoli, Alessandra Cassano, Carlo Barone

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Rationale: Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. Patientconcerns:A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia. Interventions: Serum ammonia level was 191mmol/L, liver function tests and complete blood count were normal. Regorafenib was withheld and branched chain amino acids and lactulose were administered. Outcomes: Serum ammonia level returned within the normal range, but when regorafenib was restarted at a lower dose level, a new episode of acute confusion arised. Main lesson: Discontinuation of regorafenib after confirmation of hyperammonemia is strongly recommended; reintroduction of the therapy at lower doses after resolution of symptoms related to hyperammonemic encephalopathy has to be discouraged.

Original languageEnglish
Article numbere6522
JournalMedicine (United States)
Volume96
Issue number16
DOIs
Publication statusPublished - Jan 1 2017

Fingerprint

Brain Diseases
Colorectal Neoplasms
Ammonia
Hyperammonemia
Lactulose
Branched Chain Amino Acids
Blood Cell Count
Liver Function Tests
Therapeutics
Serum
Protein-Tyrosine Kinases
Hospital Emergency Service
Reference Values
regorafenib
Safety
Liver

Keywords

  • Case report
  • Hyperammonemic encephalopathy
  • Regorafenib
  • TKI

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Quirino, M., Rossi, S., Schinzari, G., Basso, M., Strippoli, A., Cassano, A., & Barone, C. (2017). Unexpected side effect in mCRC: A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy. Medicine (United States), 96(16), [e6522]. https://doi.org/10.1097/MD.0000000000006522

Unexpected side effect in mCRC : A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy. / Quirino, Michela; Rossi, Sabrina; Schinzari, Giovanni; Basso, Michele; Strippoli, Antonia; Cassano, Alessandra; Barone, Carlo.

In: Medicine (United States), Vol. 96, No. 16, e6522, 01.01.2017.

Research output: Contribution to journalArticle

Quirino, Michela ; Rossi, Sabrina ; Schinzari, Giovanni ; Basso, Michele ; Strippoli, Antonia ; Cassano, Alessandra ; Barone, Carlo. / Unexpected side effect in mCRC : A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy. In: Medicine (United States). 2017 ; Vol. 96, No. 16.
@article{e83bc5dac3d44d87af2b443cfc5731a1,
title = "Unexpected side effect in mCRC: A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy",
abstract = "Rationale: Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. Patientconcerns:A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia. Interventions: Serum ammonia level was 191mmol/L, liver function tests and complete blood count were normal. Regorafenib was withheld and branched chain amino acids and lactulose were administered. Outcomes: Serum ammonia level returned within the normal range, but when regorafenib was restarted at a lower dose level, a new episode of acute confusion arised. Main lesson: Discontinuation of regorafenib after confirmation of hyperammonemia is strongly recommended; reintroduction of the therapy at lower doses after resolution of symptoms related to hyperammonemic encephalopathy has to be discouraged.",
keywords = "Case report, Hyperammonemic encephalopathy, Regorafenib, TKI",
author = "Michela Quirino and Sabrina Rossi and Giovanni Schinzari and Michele Basso and Antonia Strippoli and Alessandra Cassano and Carlo Barone",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000006522",
language = "English",
volume = "96",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "16",

}

TY - JOUR

T1 - Unexpected side effect in mCRC

T2 - A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy

AU - Quirino, Michela

AU - Rossi, Sabrina

AU - Schinzari, Giovanni

AU - Basso, Michele

AU - Strippoli, Antonia

AU - Cassano, Alessandra

AU - Barone, Carlo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Rationale: Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. Patientconcerns:A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia. Interventions: Serum ammonia level was 191mmol/L, liver function tests and complete blood count were normal. Regorafenib was withheld and branched chain amino acids and lactulose were administered. Outcomes: Serum ammonia level returned within the normal range, but when regorafenib was restarted at a lower dose level, a new episode of acute confusion arised. Main lesson: Discontinuation of regorafenib after confirmation of hyperammonemia is strongly recommended; reintroduction of the therapy at lower doses after resolution of symptoms related to hyperammonemic encephalopathy has to be discouraged.

AB - Rationale: Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. Patientconcerns:A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia. Interventions: Serum ammonia level was 191mmol/L, liver function tests and complete blood count were normal. Regorafenib was withheld and branched chain amino acids and lactulose were administered. Outcomes: Serum ammonia level returned within the normal range, but when regorafenib was restarted at a lower dose level, a new episode of acute confusion arised. Main lesson: Discontinuation of regorafenib after confirmation of hyperammonemia is strongly recommended; reintroduction of the therapy at lower doses after resolution of symptoms related to hyperammonemic encephalopathy has to be discouraged.

KW - Case report

KW - Hyperammonemic encephalopathy

KW - Regorafenib

KW - TKI

UR - http://www.scopus.com/inward/record.url?scp=85018273613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018273613&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000006522

DO - 10.1097/MD.0000000000006522

M3 - Article

VL - 96

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 16

M1 - e6522

ER -