内容紹介
Summary
A 60-year-old woman was administered mFOLFOX6 therapy as postoperative adjuvant chemotherapy for fStage Ⅲa ascending colon cancer. The patient developed a disorder of consciousness(Japan Coma Scale[JCS]Ⅲ-200)immediately after the completion of the therapy. Blood ammonia levels were high at 319 μg/dL, and a diagnosis of disturbance of consciousness due to hyperammonemia was made. The patient's state of consciousness improved on the following day as blood ammonia levels decreased due to treatment with branched chain amino acid(BCAA)formulation and oxygen. Two months later, mFOLFOX6 therapy was again administered with strengthening measures for side effects to nausea and vomiting and reducing 5-FU, but the patient again developed a disorder of consciousness(JCS Ⅲ-200). The 5-FU administration rate was considered as a potential cause of hyperammonemia. Hyperammonemia induced by 5-FU is relatively rare, with a reported incidence of 5-9%; however, caution is required with high dosage regimens of 5-FU that are currently recommended for colorectal cancer therapy because hyperammonemia is an important side effect.
要旨
症例は60歳,女性。fStage Ⅲaの上行結腸癌に対し術後補助化学療法としてmFOLFOX6療法を開始したところ,投与終了直後に意識障害[Japan Coma Scale(JCS)Ⅲ-200]を来した。血中アンモニア値は319 μg/dLと高値であり,高アンモニア血症による意識障害と診断し,分枝鎖アミノ酸(BCAA)製剤と酸素投与により翌日には血中アンモニア値低下とともに意識状態も改善した。2か月後,悪心・嘔吐への副作用対策強化と5-FUの減量で再度mFOLFOX6療法を試みたが,再び意識障害(JCSⅢ-200)を来した。これら一連の高アンモニア血症の原因としては,5-FU投与速度が考えられた。5-FUによる高アンモニア血症の頻度は5～9%と比較的まれであるが,現状の5-FUの高濃度持続投与レジメンが推奨されている大腸癌の抗がん剤治療においては,注意が必要な重要な副作用の一つと考えられた。
目次
A 60-year-old woman was administered mFOLFOX6 therapy as postoperative adjuvant chemotherapy for fStage Ⅲa ascending colon cancer. The patient developed a disorder of consciousness(Japan Coma Scale[JCS]Ⅲ-200)immediately after the completion of the therapy. Blood ammonia levels were high at 319 μg/dL, and a diagnosis of disturbance of consciousness due to hyperammonemia was made. The patient's state of consciousness improved on the following day as blood ammonia levels decreased due to treatment with branched chain amino acid(BCAA)formulation and oxygen. Two months later, mFOLFOX6 therapy was again administered with strengthening measures for side effects to nausea and vomiting and reducing 5-FU, but the patient again developed a disorder of consciousness(JCS Ⅲ-200). The 5-FU administration rate was considered as a potential cause of hyperammonemia. Hyperammonemia induced by 5-FU is relatively rare, with a reported incidence of 5-9%; however, caution is required with high dosage regimens of 5-FU that are currently recommended for colorectal cancer therapy because hyperammonemia is an important side effect.
要旨
症例は60歳,女性。fStage Ⅲaの上行結腸癌に対し術後補助化学療法としてmFOLFOX6療法を開始したところ,投与終了直後に意識障害[Japan Coma Scale(JCS)Ⅲ-200]を来した。血中アンモニア値は319 μg/dLと高値であり,高アンモニア血症による意識障害と診断し,分枝鎖アミノ酸(BCAA)製剤と酸素投与により翌日には血中アンモニア値低下とともに意識状態も改善した。2か月後,悪心・嘔吐への副作用対策強化と5-FUの減量で再度mFOLFOX6療法を試みたが,再び意識障害(JCSⅢ-200)を来した。これら一連の高アンモニア血症の原因としては,5-FU投与速度が考えられた。5-FUによる高アンモニア血症の頻度は5～9%と比較的まれであるが,現状の5-FUの高濃度持続投与レジメンが推奨されている大腸癌の抗がん剤治療においては,注意が必要な重要な副作用の一つと考えられた。