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Thiamine deficiency in a patient with recurrent renal cell carcinoma who developed weight loss with normal appetite and loss of energy soon after nivolumab treatment

Published online by Cambridge University Press:  19 September 2019

Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window] ,
Takashi Okabe ,
Nozomu Uchida ,
Suguru Shirotake ,
Maki Todo ,
Masafumi Oyama  and
Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window]
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Takashi Okabe
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Suguru Shirotake
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Maki Todo
Affiliation:
Department of Pharmacy, Saitama Medical University International Medical Center, Saitama, Japan
Masafumi Oyama
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama350-1298, Japan. E-mail: [email protected]
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Abstract

Background

Nivolumab has become an effective treatment option for cancer in various sites; however, this drug may cause immune-related adverse effects due to its mechanism of action. Furthermore, little has been reported on thiamine deficiency (TD) in patients receiving nivolumab treatment.

Method

From a series of cancer patients, we reported a patient with recurrent renal cell carcinoma who developed TD after the start of nivolumab treatment.

Results

A 74-year-old man with recurrent renal cell carcinoma was referred to the psycho-oncology department as he had lost about 4 kg and displayed a loss of energy after four cycles of nivolumab treatment. Psychiatric interviews revealed a decrease in energy. Neurological examination did not reveal any impairment in consciousness, ataxia, or ocular symptoms. He did not develop appetite loss. The malabsorption or overconsumption of some nutrients is thought to occur due to the rapid loss of weight; thus, a reduction in vitamin B1, which has a short storage period in the body and is often deficient in cancer patients, was suspected. The diagnosis of TD was supported by the patient's abnormally low serum thiamine level.

Significance of results

In patients treated with nivolumab, it is necessary to pay careful attention to TD when proceeding with the treatment. It is hoped that future research may reveal the link between nivolumab administration and TD.

Keywords

CancerNivolumabThiamine deficiencyWernicke encephalopathy
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 241 - 243
Copyright
Copyright © Cambridge University Press 2019

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References

REFERENCES

Abdel-Rahman, O, ElHalawani, H and Fouad, M (2015) Risk of gastrointestinal complications in cancer patients treated with immune checkpoint inhibitors: A meta-analysis. Immunotherapy 7(11), 1213–1227.CrossRefGoogle ScholarPubMed
Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer 16(8), 1041–1045.CrossRefGoogle ScholarPubMed
Basu, TK, Aksoy, M and Dickerson, JW (1979) Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy 25(2), 70–76.CrossRefGoogle ScholarPubMed
Beck, FW, Prasad, AS, Kaplan, J, et al. (1997) Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. American Journal of Physiology - Endocrinology and Metabolism 272(6 Pt 1), E1002–E1007.CrossRefGoogle Scholar
Galvin, R, Brathen, G, Ivashynka, A, et al. (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology 17(12), 1408–1418.CrossRefGoogle ScholarPubMed
Hofmann, L, Forschner, A, Loquai, C, et al. (2016) Cutaneous, gastrointestinal, hepatic, endocrine, and renal side-effects of anti-PD-1 therapy. European Journal of Cancer 60, 190–209.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Kutner, HE and Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: Under-recognized and under-treated. Psychosomatics 53(6), 507–516.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Hsu, AJ, Hatzoglou, V, Nelso, C and Breitbart, W (2015) Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative & Supportive Care 13(5), 1241–1249.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Alici, Y, Hatzoglou, V, et al. (2016a) Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57(1), 71–81.CrossRefGoogle Scholar
Isenberg-Grzeda, E, Rahane, S, DeRosa, AP, et al. (2016b) Wernicke-Korsakoff syndrome in patients with cancer: A systematic review. The Lancet Oncology 17(4), e142–e148.CrossRefGoogle Scholar
Isenberg-Grzeda, E, Shen, MJ, Alici, Y, et al. (2017) High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: Results of a single site prevalence study. Psychooncology 26(9), 1384–1389.CrossRefGoogle ScholarPubMed
Katta, N, Balla, S and Alpert, MA (2016) Does long-term furosemide therapy cause thiamine deficiency in patients with heart failure? A focused review. The American Journal of Medicine 129(7), 753.e757–753.e711.CrossRefGoogle ScholarPubMed
MacLean, LD, Rhode, BM and Shizgal, HM (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgery 198(3), 347–355.CrossRefGoogle ScholarPubMed
Onishi, H, Ishida, M, Toyama, H, et al. (2016) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative & Supportive Care 14(3), 302–306.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Takahashi, T, Taji, Y, Ikebuchi, K, Furuya, D, Uchida, N and Akechi, T (2018a) Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer. Palliative & Supportive Care 16(6), 800–802.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018b) Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic. Palliative & Supportive Care 16(5), 633–636.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018c) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative & Supportive Care 16(4), 497–499.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018d) Wernicke encephalopathy without delirium in patients with cancer. Palliative & Supportive Care 16(1), 118–121.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Uchida, N, et al. (2018e) Subclinical thiamine deficiency identified by preoperative evaluation in an ovarian cancer patient: Diagnosis and the need for preoperative thiamine measurement. Palliative & Supportive Care, 1–2.Google Scholar
Onishi, H, Ishida, M, Kagamu, H, Murayama, Y, Kobayashi, K, Sato, I, Uchida, N and Akechi, T (2019) Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliative & Supportive Care 17, 245–247.CrossRefGoogle Scholar
Pardanani, A, Harrison, C, Cortes, JE, et al. (2015) Safety and efficacy of fedratinib in patients with primary or secondary myelofibrosis: A randomized clinical trial. JAMA Oncology 1(5), 643–651.CrossRefGoogle ScholarPubMed
Prasad, AS (1995) Zinc: An overview. Nutrition 11(1 Suppl), 93–99.Google ScholarPubMed
Rieck, J, Halkin, H, Almog, S, et al. (1999) Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. Journal of Laboratory and Clinical Medicine 134(3), 238–243.CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. The Lancet Neurology 6(5), 442–455.CrossRefGoogle ScholarPubMed
Sechi, G, Batzu, L, Agro, L, et al. (2016a) Cancer-related Wernicke-Korsakoff syndrome. The Lancet Oncology 17(6), e221–e222.CrossRefGoogle Scholar
Sechi, G, Sechi, E, Fois, C, et al. (2016b) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281–300.CrossRefGoogle Scholar
Seligmann, H, Halkin, H, Rauchfleisch, S, et al. (1991) Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: A pilot study. The American Journal of Medicine 91(2), 151–155.CrossRefGoogle ScholarPubMed
Smidt, LJ, Cremin, FM, Grivetti, LE, et al. (1991) Influence of thiamin supplementation on the health and general well-being of an elderly Irish population with marginal thiamin deficiency. Journal of Gerontology 46(1), M16–M22.CrossRefGoogle ScholarPubMed
Victor, M, Adams, RD and Collins, GH (1971) The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Series 7, 1–206.Google ScholarPubMed
Yae, S, Okuno, S, Onishi, H, et al. (2005) Development of Wernicke encephalopathy in a terminally ill cancer patient consuming an adequate diet: A case report and review of the literature. Palliative & Supportive Care 3(4), 333–335.CrossRefGoogle Scholar
Zimmer, L, Goldinger, SM, Hofmann, L, et al. (2016) Neurological, respiratory, musculoskeletal, cardiac and ocular side-effects of anti-PD-1 therapy. European Journal of Cancer 60, 210–225.CrossRefGoogle ScholarPubMed