Soliris effective in managing man’s chemotherapy-induced aHUS

Disease diagnosed after 19 cycles of treatment for rare liver cancer

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A researcher examining samples under a microscope in a lab.

Soliris (eculizumab) was effective in managing atypical hemolytic uremic syndrome (aHUS), which arose in a man as a side effect of chemotherapy treatment with gemcitabine.

“The mainstay management decision [for gemcitabine-related aHUS] is the prompt discontinuation of gemcitabine therapy, and while this is effective in some patients, complement inhibitors [such as Soliris] may be required for further management of this rare disorder,” the researchers wrote.

The study, “Eculizumab in the Treatment of Gemcitabine-Induced Atypical Hemolytic Uremic Syndrome,” was published in the journal Cureus.

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aHUS symptoms eased after two treatments with Soliris

Cholangiocarcinoma is a rare form of liver cancer. The current gold standard for treating this type of cancer is a combination of two chemotherapy medications, gemcitabine and cisplatin.

Gemcitabine is known to induce aHUS as a rare, but serious, side effect. The mechanism behind this side effect is unknown.

A team of U.S. scientists described the case of a 60-year-old man, diagnosed with cholangiocarcinoma after going to the hospital with complaints of abdominal pain and jaundice, marked by yellowed skin and eyes.

After the diagnosis of liver cancer was confirmed with imaging tests and biopsies, the man was started on standard gemcitabine and cisplatin combination therapy. However, cisplatin was stopped early due to peripheral neuropathy — damage to the nerves located outside the brain and spinal cord. He then continued treatment with gemcitabine alone.

Over the next 15 months, he underwent 19 gemcitabine treatment cycles. The man then returned to the hospital with complaints of shortness of breath, severe fatigue, and swelling in his legs.

Laboratory tests found signs of kidney damage, red blood cell destruction, and low platelet counts, a trio of clinical signs that characterizes aHUS.

“Studies show that drug-induced HUS almost always presents with severe kidney injury, as seen in our patient,” the scientists wrote.

After the diagnosis of aHUS, gemcitabine was discontinued, but the patient’s symptoms persisted for another two weeks. He was then started on Soliris, a widely approved aHUS therapy that works by blocking the activation of the complement cascade — a part of the immune system that is overly active in aHUS.

After two doses of Soliris, his swelling and shortness of breath eased.

“Given our patient’s rapid improvement, [Soliris] was discontinued at discharge, with plans for monitoring laboratory parameters every two weeks at the leukemia clinic and future plans for genetic testing,” the researchers wrote.

Soliris is sold by AstraZeneca, which was not involved with this report.