Abstract
BackgroundDespite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed. Accordingly, it is not known whether these agents are safe for use in patients with porphyria.Case presentationIn this report, we present a case of an invasive mole with lung metastasis in a 49-year-old Japanese woman who had previously been diagnosed with acute intermittent porphyria at 27 years of age but had no recent history of acute intermittent porphyria attacks. Her serum human chorionic gonadotropin level was elevated 1 month after hysterectomy, and she was referred to our center for chemotherapy. After she received 100 mg of methotrexate, drug eruptions were observed starting on day 3 and grew progressively worse. Erythema and mucosal erosion spread throughout her body, whereupon she was administered prednisolone. In addition, our patient experienced febrile neutropenia and required granulocyte colony- stimulating factor treatment. No changes in our patient’s urinary coproporphyrin or uroporphyrin levels were detected during this entire episode. Methotrexate was replaced by actinomycin D (0.5 mg/body intravenously on days 1–5 every 2 weeks). After five uneventful cycles of actinomycin D, our patient achieved and maintained a normal serum human chorionic gonadotropin level for 3 years.ConclusionsMethotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; however, severe adverse effects were noted with methotrexate. Although further investigation is required, our data suggest that these agents are nonporphyrinogenic and can therefore be used to treat patients with comorbid porphyria.
Highlights
Despite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed
Methotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; severe adverse effects were noted with methotrexate
Further investigation is required, our data suggest that these agents are nonporphyrinogenic and can be used to treat patients with comorbid porphyria
Summary
Given the rare nature of porphyrias, knowledge regarding the safe use of chemotherapeutic agents in these patients will require evidence from additional case reports. Nonporphyrinogenic (case reports): Mitomycin C, cyclophosphamide, mitoxantrone, 5-fluorouracil, cytosine arabinoside, doxorubicin, 6-thioguanine, vincristine, procarbazine, methotrexate, actinomycin D, cisplatin cause of this pain. I did not experience any more abdominal pain attacks beginning at 33 years of age; I felt uneasy about receiving chemotherapy. My husband and I listened to an explanation about another anticancer agent from a doctor in the outpatient department 1 week later She told us that the medicine, actinomycin D, had not been evaluated for use in patients with AIP. The doctor told me that I would usually need to receive three additional courses of chemotherapy after the serum hCG level fell below the cutoff level, but my serum hCG level remained under the cutoff level 1 month after stopping the second chemotherapy.
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