Ifosfamide extrapyramidal neurotoxicity

Article Abstract:

Ifosfamide is a chemotherapeutic agent closely related to cyclophosphamide, but ifosfamide has toxic effects on the central nervous system which are unlike those caused by cyclophosphamide. While different studies have reported differing percentages, it seems to be commonly found that a minority of patients treated with ifosfamide develop neurological symptoms including seizures, confusion, and inability to speak. Generally, these symptoms resolve 48 to 72 hours after the ifosfamide treatment is stopped. However, in some cases the neurological damage seems to be irreversible; cases of both irreversible coma and death have been described. A case has now been seen in which a patient treated with ifosfamide developed extrapyramidal motor symptoms. Extrapyramidal motor symptoms are, by definition, associated with parts of the central nervous system outside the pyramidal tract, which connects the portion of the cerebral cortex involved with movement to the spinal cord and muscles. The patient was a 61-year-old man who developed an enlarging abdominal mass while at the same time losing almost 30 pounds. Examination revealed that the patient had simultaneously developed both lung cancer and lymphoma. Chemotherapy was begun with a combination protocol including cisplatin, etoposide, and ifosfamide. The patient became confused and agitated on the fifth day of treatment. He developed muscle spasticity and myoclonus, or spasms of muscles. The patient also had generalized choreoathetosis, a condition including writhing, snakelike movements which are highly organized but involuntary. The patient became mute as well. An electroencephalogram revealed brain electrical activity which was consistent with a severe metabolic abnormality of the brain. No lesions of stroke or tumor were visible on the computed tomography scan. The treatment was discontinued, and over the next 72 hours the patient's symptoms resolved and his mental status returned to normal. The case illustrates that extrapyramidal motor symptoms must be included among the potential neurological side effects caused by ifosfamide. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Causes of, Physiological aspects, Neurotoxic agents, Ifosfamide, Extrapyramidal disorders

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The epidermal growth factor receptor and the prognosis of bladder cancer

Article Abstract:

Epidermal growth factor is a high molecular weight protein that stimulates the growth of a wide variety of cells under normal circumstances. It is found in high concentrations in urine, which is thought to indicate secretion by cells of the kidney tubules. The action of epidermal growth factor is mediated by a growth factor receptor on the surface of target cells. In some tumors, such as gliomas, there may be an amplification of the gene for the epidermal growth factor receptor. Although this seems not to occur in bladder cancer, epidermal growth factor receptors (EGFr) have been identified on bladder tumors, and their presence correlates with tumor category and grade. To determine if the presence of EGFr has prognostic value for bladder cancer, 101 patients were prospectively studied. Of the 101 tumors, 49 were positive for the EGFr. The EGFr-positive tumors were larger and of a higher grade than the negative tumors. Death was strongly associated with EGFr-positive tumors, and this was true even when other prognostic factors were taken into account. Tumors positive for the epidermal growth factor receptor were more likely to result in tumor recurrence, tumor progression, and death. The high rate of EGFr presence on bladder cancer cells, and the poor prognosis which follows from its presence, may stimulate the development of specifically targeted drugs which can bind to this receptor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Prognosis, Growth factors, Growth factor receptors, Bladder cancer

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