Evidence map›Paper›PMID 33011861›Full record

ArticleCancer chemotherapy and pharmacology2020

Successful management of hyperammonemia with hemodialysis on day 2 during 5-fluorouracil treatment in a patient with gastric cancer: a case report with 5-fluorouracil metabolite analyses.

Yoshinao Ozaki, Hirotaka Imamaki, Aki Ikeda, Mitsuaki Oura, Shunsaku Nakagawa, Taro Funakoshi, Shigeki Kataoka, Yoshitaka Nishikawa, Takahiro Horimatsu, Atsushi Yonezawa and 4 more

Erratum issuedOpen access · hybridAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Cancer chemotherapy and pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.5field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 8 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 1 country.

Yoshinao OzakiDepartment of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan. yoshinao@kuhp.kyoto-u.ac.jp.ORCID 0000-0002-3554-7271
Hirotaka ImamakiDepartment of Nephrology, Hirakata Kohsai Hospital, Osaka, Japan.
Aki IkedaDepartment of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan.
Mitsuaki OuraFaculty of Medicine, The University of Tokyo, Tokyo, Japan.
Shunsaku NakagawaDepartment of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan.
Taro FunakoshiDepartment of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Shigeki KataokaDepartment of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yoshitaka NishikawaDepartment of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Takahiro HorimatsuDepartment of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Atsushi YonezawaDepartment of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan.
Takeshi MatsubaraDepartment of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Motoko YanagitaDepartment of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Manabu MutoDepartment of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Norihiko WatanabeDepartment of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan.
Kyoto University · JPMunicipal Hirakata City Hospital · JPKyoto University Hospital · JPThe University of Tokyo · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeHyperammonemia is an important adverse event associated with 5-fluorouracil (5FU) from 5FU metabolite accumulation. We present a case of an advanced gastric cancer patient with chronic renal failure, who was treated with 5FU/leucovorin (LV) infusion chemotherapy (2-h infusion of LV and 5FU bolus followed by 46-h 5FU continuous infusion on day 1; repeated every 2 weeks) and developed hyperammonemia, with the aim of exploring an appropriate hemodialysis (HD) schedule to resolve its symptoms.

methodsThe blood concentrations of 5FU and its metabolites, α-fluoro-β-alanine (FBAL), and monofluoroacetate (FA) of a patient who had hyperammonemia from seven courses of palliative 5FU/LV therapy for gastric cancer were measured by liquid chromatography-mass spectrometry.

resultsOn the third day of the first cycle, the patient presented with symptomatic hyperammonemia relieved by emergency HD. Thereafter, the 5FU dose was reduced; however, in cycles 2-4, the patient developed symptomatic hyperammonemia and underwent HD on day 3 for hyperammonemia management. In cycles 5-7, the timing of scheduled HD administration was changed from day 3 to day 2, preventing symptomatic hyperammonemia. The maximum ammonia and 5FU metabolite levels were significantly lower in cycles 5-7 than in cycles 2-4 (NH3 75 ± 38 vs 303 ± 119 μg/dL, FBAL 13.7 ± 2.5 vs 19.7 ± 2.0 μg/mL, FA 204.0 ± 91.6 vs 395.9 ± 12.6 ng/mL, mean ± standard deviation, all p < 0.05). After seven cycles, partial response was confirmed.

conclusionHD on day 2 instead of 3 may prevent hyperammonemia in 5FU/LV therapy.

Indexed as

Renal DialysisAged, 80 and overAmmoniaAntimetabolites, Antineoplasticbeta-AlanineDrug Administration ScheduleFluoroacetatesFluorouracilHumansHyperammonemiaMaleStomach NeoplasmsTime FactorsTreatment Outcomealpha-fluoro-beta-alanineAmmoniaAntimetabolites, Antineoplasticbeta-AlanineFluoroacetatesfluoroacetic acidFluorouracil5-FluorouracilChronic renal failureHyperammonemiaPharmacokinetics

Identifiers

PMID33011861
PMCPMC7595983
OpenAlexW3091041191

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.