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Journal of Cancer Research and Therapeutics, Vol. 7, No. 2, April-June, 2011, pp. 201-202 Case Report Severe lactic acidosis in a patient with metastatic prostate cancer Javier Munoz, Mohd Khushman, Amr Hanbali, Michael Stoltenberg Department of Hematology-Oncology, Henry Ford Hospital, CFP-5, 2799 West Grand Boulevard, Detroit, MI 48202, USA Code Number: cr11048 PMID: 21768714 Abstract Lactic acidosis (LA) due to malignancy was first reported in patients with acute leukemia. Since then, several malignancies have been reported to be associated with LA. The pathophysiology of cancer-related LA is multifactorial and still poorly understood. In general, chemotherapy is the only effective mean of correcting malignancy-related LA by cytoreduction of the tumor cells while at the same time decreasing malignant liver involvement leading to improved clearance of lactic acid. LA is rare in patients with malignancies and is usually associated with high mortality because of advanced disease process and high tumor burden. Increased awareness of this complication in certain malignancies is important because early initiation of chemotherapy may decrease LA and perhaps prolong survival. To our knowledge, this is the first case of otherwise unexplained severe LA in a patient with chemotherapy-refractory metastatic prostate cancer.Keywords: Chemotherapy, lactic acidosis, prostate cancer Introduction Lactic acidosis (LA) due to malignancy was first reported in patients with acute leukemia by Field et al. [1] Since then, several malignancies have been reported to be associated with LA. Highly active mitotic tumors such as leukemia or lymphoma (in hematologic malignancies) and small cell carcinoma (in solid tumors) are more often associated with LA. [2],[3],[4],[5],[6],[7],[8] Case Report A 71-year-old man known to have stage IV chemotherapy-refractory adenocarcinoma of the prostate with widespread liver [Figure - 1] and bone metastases [Figure - 2] that had progressed despite multiple therapeutic regimens in the past including combined androgen deprivation therapy followed by chemotherapy (taxotere, gemcitabine, prednisone, and mitoxantrone) was scheduled to receive palliative radiotherapy of his left femur and right scapula. While receiving radiotherapy, his prostate-specific antigen increased from just over 300 to 1186.8 ng/mL in a period of 10 weeks [Figure - 3]. Prior to starting scheduled chemotherapy with estramustine, the patient was admitted to the hospital because of shortness of breath and respiratory distress which required intubation and mechanical ventilation. He had no associated fevers, chest pain or productive cough. Complete blood count showed no neutropenia. Arterial blood gas showed severe LA (pH as low as 7.07; lactate as high as 22 mmol/L) that was resistant to sodium bicarbonate infusions. Computed tomography scan of the body did not show a source of infection. Other causes of LA, such as circulatory failure or medications, were ruled out. After discussing about the risks and benefits of further chemotherapy, the family decided to pursue comfort care measures thus the patient expired shortly after extubation. Discussion The pathophysiology of cancer-related LA remains elusive. Its mechanism is multifactorial and likely includes liver dysfunction and metastasis leading to lactate underutilization by liver gluconeogenesis. [9] Overexpression of hexokinase, [9],[10] causing a high rate of glycolysis in cancer cells may play a role. Another possible mechanism is that highly active mitotic solid tumors may outgrow their blood supply creating a hypoxic microenvironment and subsequently produce further lactic acid. Regardless of the mechanism of cancer-related LA, its presence portends a poor prognosis. In general, chemotherapy is the only effective means of correcting malignancy-related LA. [2],[9] Chemotherapy seems to exert its effects by cytoreduction of the tumor cells while at the same time decreasing malignant liver involvement leading to improved clearance of lactic acid. LA is rare in patients with malignancies and is usually associated with high mortality because of advanced disease process and high tumor burden. Increased awareness of this complication in certain malignancies is important because early initiation of chemotherapy may decrease LA and perhaps prolong survival. To our knowledge, this is the first case of otherwise unexplained severe LA in a patient with chemotherapy-refractory metastatic prostate cancer. References
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11048f3.jpg] [cr11048f2.jpg] [cr11048f1.jpg] |
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