Cisplatin-induced sudden cardiac death with hemodynamic collapse: a severe adverse drug reaction: Case report

Our plain-English summary of Cisplatin-induced sudden cardiac death with hemodynamic collapse: a severe adverse drug reaction: Case report, by S. Abramavicius, M. Zemaitis, V. Pilvinis, et al (Medicine, 2017).

The study

• Authors: S. Abramavicius, M. Zemaitis, V. Pilvinis, E. Kadusevicius
• Journal: Medicine
• Published: 2017;96(48):e8995
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Cisplatin is responsible for a significant percentage of adverse drug reactions (ADRs) in oncology setting. A great proportion of cisplatin-induced severe adverse events are difficult to foresee, and giving premedication does not always prevent the occurrence of such events.

Patient Concerns: A 53-year-old woman with progressive T4 N0 M0 stage IV pleural mesothelioma experienced cardiac arrest with hemodynamic collapse after cisplatin and pemetrexed chemotherapy administration.

Diagnoses: Progressive pleural T4 N0 M0 stage IV mesothelioma of the right lung, primary arterial hypertension, and cardiac arrest with hemodynamic collapse.

Interventions: The cisplatin and pemetrexed chemotherapy was administered intravenously for progressive pleural T4 N0 M0 stage IV mesothelioma of the right lung. During infusion of cisplatin the patient developed cardiac arrest, and cardiopulmonary resuscitation was initiated.

Outcomes: The patient was treated in intensive care unit and recovered successfully. Further chemotherapy with cisplatin and pemetrexed was withheld due to this severe adverse reaction to cisplatin.

Lessons: Cisplatin therapy should be thoroughly monitored including electrolyte, especially magnesium levels. Absence of previous ADRs to cisplatin and premedication should not give false sense of security.

In plain English

This case report, by authors at the Lithuanian University of Health Sciences in Kaunas, described one patient: a 53-year-old woman with progressive stage IV pleural mesothelioma of the right lung, who also had primary arterial hypertension. She had received cisplatin and pemetrexed chemotherapy in 2015. The treatment was restarted in November 2016 after the disease progressed. On the day described, her blood tests showed no significant abnormalities and she received premedication. During the intravenous cisplatin infusion she became unresponsive and her heart stopped. Resuscitation restored a normal heart rhythm and circulation at the 12th minute. She was treated in intensive care and recovered. Tests ruled out acute coronary syndrome, neurological disease, pulmonary embolism, and abnormal potassium and sodium levels, but magnesium was not measured. The authors judged the event a severe adverse drug reaction most likely caused by cisplatin, possibly made more likely by interactions among her many medicines. Further cisplatin and pemetrexed were withheld. The authors concluded that cisplatin therapy should be thoroughly monitored.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 53-year-old Caucasian woman working in the service sector, with progressive pleural T4 N0 M0 stage IV mesothelioma of the right lung (diagnosed 2015) and primary arterial hypertension. The event occurred in 2016. The authors are at the Lithuanian University of Health Sciences, Kaunas, Lithuania.
• Exposure: Intravenous cisplatin (150 mg per day per Table 2) with pemetrexed chemotherapy, given after premedication (dexamethasone, folic acid, cyanocobalamin, mannitol, ondansetron). Other medicines included aprepitant, fentanyl patch, tramadol, metoprolol, alprazolam, tianeptine and a shark cartilage extract. Asbestos exposure is not discussed.
• Main results:
  • Before the infusion, the patient's complete blood count and metabolic panel showed no significant abnormalities.
  • During the cisplatin infusion, the patient became unresponsive and had a cardiopulmonary arrest.
  • Normal heart rhythm and spontaneous circulation returned at the 12th minute of resuscitation.
  • The patient was treated in the intensive care unit and recovered.
  • Acute coronary syndrome, neurological disease, pulmonary embolism and potassium or sodium imbalance were excluded, but magnesium levels were not evaluated.
  • The event was identified as a drug-related severe adverse drug reaction, likely caused by cisplatin and possibly predisposed by multiple drug interactions.
  • Further chemotherapy with cisplatin and pemetrexed was withheld, and best supportive care became the main goal.
• The authors' conclusion: The authors concluded that this was a suspected severe adverse drug reaction most likely caused by cisplatin after repeated exposure. They suggested possible mechanisms: an anaphylactic reaction, direct cardiotoxicity, or electrolyte imbalance (especially low magnesium). They said other drugs and their interactions could have contributed, that premedication should not give a false sense of safety, and that cisplatin therapy should be thoroughly monitored.
• Limitations the authors state:
  • Magnesium levels were not measured, so the authors could not rule out low magnesium as a contributor.

Topics

Medical terms in this study, explained in our Lexicon: Cisplatin, Pleural Mesothelioma, Pemetrexed (Alimta), Chemotherapy, Mesothelioma.

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