Dr GHIA SPANGENBERG1,2, Dr RAJIV JUNEJA1,2, Dr CHIANG LEE1,2, A/Prof JORDAN LI1,2
1Renal Unit, Flinders Medical Centre, Bedford Park, Australia , 2College of Medicine and Public Health, Flinders University, Bedford Park, Australia
Background:
Trabectedin is an alkylating chemotherapy agent used as a second line treatment for unresectable or metastatic sarcoma. Rhabdomyolysis has been reported as a known but rare side effect of trabectedin. Rhabdomyolysis is the clinical syndrome resulting from elevated creatine kinase (CK) as a consequence of skeletal muscle injury, with clinical features ranging from benign myalgias to multi-organ failure including acute kidney injury (AKI).
Case Report:
This case involves a 67-year-old male first diagnosed with myxoid liposarcoma in 2010. He was initially managed with surgical excision with adjuvant chemoradiotherapy but was subsequently commenced on trabectedin due to disease progression in 2022. One month later, features of acute cholecystitis were incidentally noted on a staging computer topography scan resulting in referral to the emergency department. Admission bloods demonstrated pancytopenia, a mixed liver injury and an AKI with a creatinine of 325µmol/L (60-110µmol/L), from a normal baseline. Trabectedin was ceased. He was initially treated with empiric antibiotics but despite this developed a progressive oliguric AKI. In investigating the underlying aetiology of the AKI, rhabdomyolysis secondary to trabectedin was queried and subsequently confirmed with a CK of 21166U/L. He failed to improve despite aggressive fluid resuscitation and required haemodialysis. He remained dialysis dependent for one month prior to renal recovery. His current creatinine is 127µmol/L.
Conclusions:
Rhabdomyolysis is an important but rare and idiosyncratic side effect of trabectedin, with cases of severe disease resulting in anuric AKI requiring haemodialysis being exceedingly rare. Prompt recognition is imperative to prevent potentially irreversible consequences. This case highlights the need for judicious monitoring of CK levels prior to each cycle of trabectedin.
Biography:
My name is Ghia Spangenberg and I am a third year General Medicine Advanced Trainee with an interest in nephrology.