Small Cell Lung Cancer Patient with Profound Hyponatremia and Acute Neurological Symptoms: An Effective Treatment with Fludrocortisone

Hyponatremia is a frequent electrolyte abnormality in patients with small cell lung cancer (SCLC). Being usually asymptomatic, hyponatremia may cause symptoms like nausea, fatigue, disorientation, headache, muscle cramps, or even seizures, particularly if severe and rapid decrease of serum sodium levels occurs. Here we report a case of SCLC patient with severe hyponatremia and acute neurological symptoms that developed 2 days after the first course of second-line chemotherapy, most probably due to the release of antidiuretic hormone (ADH, also known as arginine vasopressin) during lysis of the tumour cells. Initial treatment consisted of continuous administration of hypertonic saline that resulted in improvement of patient’s neurological status. However, to obtain a persistent increase in serum sodium level, pharmacological intervention with oral fludrocortisone 0.1 mg twice daily was needed. We can therefore conclude that mineralocorticoids may be used to correct hyponatremia in SCLC patients when appropriate.

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Continuous Administration of Daily Low-Dose Temozolomide in Pretreated Patients with Advanced Non-Small Cell Lung Cancer: A Phase II Study

Oncology ◽

10.1159/000192586 ◽

2009 ◽

Vol 76 (2) ◽

pp. 112-117 ◽

Cited By ~ 22

Author(s):

Charalambos Kouroussis ◽

Lambros Vamvakas ◽

Nikolaos Vardakis ◽

Athanasios Kotsakis ◽

Antonia Kalykaki ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Phase Ii ◽

Cell Lung Cancer ◽

Low Dose ◽

Phase Ii Study ◽

Small Cell ◽

Small Cell Lung ◽

Continuous Administration ◽

Pretreated Patients

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DDRE-05. LONG-TERM OUTCOME OF INTRATHECAL CHEMOTHERAPY WITH PEMETREXED IN LEPTOMENINGEAL METASTASIS FROM NON-SMALL CELL LUNG CANCER WITH EGFR-MUTATION: A CASE REPORT

Neuro-Oncology ◽

10.1093/neuonc/noab196.289 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi75-vi75

Author(s):

hui Wang ◽

Jiangfen Zhou ◽

Lei Wen ◽

Weiping Hong ◽

Linbo Cai

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Egfr Mutation ◽

Leptomeningeal Metastasis ◽

Intrathecal Chemotherapy ◽

Small Cell ◽

Neurological Symptoms ◽

Small Cell Lung ◽

Long Term Outcome

Abstract Leptomeningeal metastasis (LM) is fatal complication of non-small cell lung cancer (NSCLC) ,which has a poor prognosis and lacks effective treatments. Pemetrexed, a multitargeted antifolate agent, has demonstrated antitumor activity, a few studies have shown intrathecal pemetrexed (IP) controllable toxicities and potential promising efficacy for LM from NSCLC patients. We report a patient who diagnosed with LM from NSCLC harboring epidermal growth factor receptor (EGFR) mutation in exons 21 via typical neurological symptoms, magnetic resonance imaging (MRI) and positive cerebrospinal fluid (CSF) cytology. The curative effect of tyrosine kinase inhibitor (TKI) targeted drugs was maintained for a short time, the first-generation TKI icotinib was 4 months, and the third-generation osimertinib was 4 months. Then the patient received IP, and osimertinib continued. 30 mg of pemetrexed were implemented on day 1 every weeks for 8 weeks via lumbar puncture, then 50 mg of pemetrexed on day 1 every 4 week for 8 times. This treatment regimen resulted in the alleviation of the neurological symptoms, the CSF level of carcinoembryonic antigen also decresed without obvious side effects. At the time of this manuscript’s submission, she had maintained stable disease (SD) for more than 11 months. To our knowledge, this study provides the first clinical evidence that longterm intrathecal chemotherapy with pemetrexed providing a therapeutic approach against LM from NSCLC.

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