Editorial Comment to Tumor lysis syndrome following cabazitaxel administration for metastatic castration‐resistant prostate cancer: A case report

Abstract

I read with great interest the case report by Oshima et al. The authors presented a suggestive tumor lysis syndrome (TLS) case following cabazitaxel administration for metastatic castration-resistant prostate cancer (CRPC). This case is very interesting in terms of rarity of TLS in prostate cancer. The patient was a 77-year-old man who developed clinical TLS after a single dose of cabazitaxel for metastatic CRPC. With hydration and the recombinant uricolytic agent, rasburicase, his condition once improved, yet he died of multiple organ failure in a few weeks. TLS is considered as one of the major oncological emergencies and a potentially lethal complication of anticancer treatment. Pathophysiologically, large numbers of neoplastic cells are killed rapidly, leading to the release of large amounts of intracellular ions and metabolic byproducts into systemic circulation. Usually, laboratory or clinical TLS is defined as the presence of biochemical abnormalities and clinical complications before and after chemotherapy or other treatments. So far, nine cases of TLS have been reported in patients with prostate cancer including the present case. All of the nine cases had evidence of metastatic disease, and six cases had CRPC. Especially, this case of TLS after cabazitaxel therapy was reported for the first time in prostate cancer. To avoid fatal outcomes of TLS, some risk factors should be considered in anticancer treatment. Certain tumor and patient characteristics can be used to predict the risk of future TLS (e.g. highly proliferating and bulky malignancy, sensitivity to chemotherapy, and exposure to nephrotoxic substances, such as nonsteroidal anti-inflammatory agents and certain antihypertensive medications). Other potential risk factors include the presence of decreased renal function and elevated lactate dehydrogenase (LDH), phosphorus, potassium, and uric acid (UA) levels. In this case, abnormal LDH and potassium levels and renal function already existed before starting cabazitaxel administration. Hydration and rasburicase are recommended as both prevention and treatment for TLS in major purpose of preserving renal function. Rasburicase can preserve or improve renal function and reduce serum phosphorus levels as secondary beneficial effects and is considered to be more effective than allopurinol for the prevention and treatment of TLS because it prevents xanthine accumulation and directly breaks down UA. In this case, rasburicase might be the better option rather than allopurinol for the treatment of established TLS. Of course, it is extremely important to assess the risk factors for TLS and to perform active prevention procedures to avoid fatal outcomes.