SHARE @ Advocate Health - Midwest - Scientific Day: Tumor Lysis Syndrome in Non-Small Cell Lung Cancer: A Devastating Complication in an Unexpected Space
 

Affiliations

Aurora St. Luke's Medical Center

Abstract

Introduction/Background:

Tumor lysis syndrome (TLS) is a feared complication of anticancer therapy that results from massive tumor cell death and release of tumor cell contents into the circulation. It is commonly seen in hematologic malignancies such as acute leukemias and clinically aggressive lymphomas and rarely occurs in solid tumors. TLS can rapidly lead to permanent kidney damage and death even with appropriate, aggressive treatment.

Description:

A 67-year-old male began neoadjuvant treatment with cisplatin, gemcitabine, and nivolumab for stage IIIA squamous cell carcinoma of the lung. On day four, he presented to the emergency room for confusion and anuria and was found to be in acute renal failure with potassium 6.8 mmol/L, blood urea nitrogen 106 mg/dL, creatinine 6.67 mg/dL (baseline 0.7-1.0 mg/dL), calcium 8.2 mg/dL, phosphorus 11.9 mg/dL, uric acid 14.1 mg/dL, and LDH 351 U/L (normal range 86-234 U/L). He was treated with rasburicase, IV fluids, and urgent hemodialysis with improvement in his electrolyte disturbances, but unfortunately his kidney function did not recover, and he subsequently required three times weekly hemodialysis.

Discussion:

Tumor lysis syndrome is rare in lung cancers, and even more so in non-small cell lung cancer (NSCLC). There are currently 12 reported cases of TLS in NSCLC indexed in PubMed, 11 of which occurred in the setting of metastatic disease. Our case appears to be the first report of TLS in non-metastatic squamous cell carcinoma of the lung following initiation of systemic therapy. Known risk factors for TLS in solid tumors include bulky disease, rapidly growing tumors, and high sensitivity to anticancer therapy. Combination cytotoxic chemotherapy is the most commonly implicated trigger in TLS; the relative risk of TLS following immunotherapy is unknown. Currently, routine prophylaxis with urate-lowering medication is not recommended for most solid tumors including NSCLC. Understanding risk factors for solid tumor TLS is key for prevention and early intervention in order to minimize its frequently devastating outcomes.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

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May 21st, 11:41 AM May 21st, 1:15 PM

Tumor Lysis Syndrome in Non-Small Cell Lung Cancer: A Devastating Complication in an Unexpected Space

Introduction/Background:

Tumor lysis syndrome (TLS) is a feared complication of anticancer therapy that results from massive tumor cell death and release of tumor cell contents into the circulation. It is commonly seen in hematologic malignancies such as acute leukemias and clinically aggressive lymphomas and rarely occurs in solid tumors. TLS can rapidly lead to permanent kidney damage and death even with appropriate, aggressive treatment.

Description:

A 67-year-old male began neoadjuvant treatment with cisplatin, gemcitabine, and nivolumab for stage IIIA squamous cell carcinoma of the lung. On day four, he presented to the emergency room for confusion and anuria and was found to be in acute renal failure with potassium 6.8 mmol/L, blood urea nitrogen 106 mg/dL, creatinine 6.67 mg/dL (baseline 0.7-1.0 mg/dL), calcium 8.2 mg/dL, phosphorus 11.9 mg/dL, uric acid 14.1 mg/dL, and LDH 351 U/L (normal range 86-234 U/L). He was treated with rasburicase, IV fluids, and urgent hemodialysis with improvement in his electrolyte disturbances, but unfortunately his kidney function did not recover, and he subsequently required three times weekly hemodialysis.

Discussion:

Tumor lysis syndrome is rare in lung cancers, and even more so in non-small cell lung cancer (NSCLC). There are currently 12 reported cases of TLS in NSCLC indexed in PubMed, 11 of which occurred in the setting of metastatic disease. Our case appears to be the first report of TLS in non-metastatic squamous cell carcinoma of the lung following initiation of systemic therapy. Known risk factors for TLS in solid tumors include bulky disease, rapidly growing tumors, and high sensitivity to anticancer therapy. Combination cytotoxic chemotherapy is the most commonly implicated trigger in TLS; the relative risk of TLS following immunotherapy is unknown. Currently, routine prophylaxis with urate-lowering medication is not recommended for most solid tumors including NSCLC. Understanding risk factors for solid tumor TLS is key for prevention and early intervention in order to minimize its frequently devastating outcomes.

 

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