A 60y/o woman with stage IV breast cancer (OSS, PER), ER / PR +, Her2 -, previous illnesses: HTN, devlops a recurrent ascites under the Treatment with letrozole + palbociclib, additionally to arterial hypotension, sleightly elevated creatinine 1.3 mg / ml, hyperkalemia up to 7 mmol / l, hyponatremia up to 118 mmol / l, compensated metabolic acidosis with BE of -7 und a hypoalbuminemia of 18 g / l. SIADH and hypocortisolism are excluded. What could be the cause for this clinical and laboratorypicture?
It may be the Tumor Lysis Syndrome, either spontaneous or chemotherapy induced. To confirm, serum uric acid, phosphate and calcium levels should be also determined.
Uric acid, phosphate, corricated calcium are normal. LDH was slightly elevated and stable from Anfang, what the TLS is very unlikely.
Difficult case! I'd ask if the Ascitis is a tumoral ascitis, meaning positive cytology, and if there is any previous history of Liver disease, of Viral Hepatitis markers. Previous Breast cancer therapy? Did she ever receive Fulvestrant? The Letrozole Side Effects patient warning include the indication of telling the phsyician if having ever had liver disease. As first measure, I'd withdraw both drugs, and have the common Hyperkalemia workup, as described in 'The Washington Manual of Medical Therapeutics'. PMID 31978257 PMID 24861776 PMID 26671516 PMID 31563217 I had a good result in a patient with Breast cancer ascites with positive cytology with a single IP 3 gr 5-FU dose, and a draining paracenthesis a few days later, but info about liver and ascites in this case may be incomplete.
Thanks. Salut +
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