Abstract
BackgroundWe describe a case of pemetrexed toxicities related to reabsorption by an ileal neobladder, which caused prolonged hematotoxicity and nephrotoxicity.Case presentationA 59-year-old white man was diagnosed with metastatic wild-type adenocarcinoma of the upper lobe of his right lung. After a first cycle of cisplatin and pemetrexed, he had unusually prolonged aplasia and acute kidney injury.The prolonged aplasia was caused by pemetrexed reabsorption by the ileal mucosa of the neobladder as pemetrexed was eliminated renally in an active form and is partly lipophilic.ConclusionsPemetrexed may be reabsorbed by the ileal mucosa of the neobladder because of its hydrophobic structure and renal excretion in its active form. Acute urinary retention may maintain this phenomenon. Published data excluded a potential role for cisplatin in this toxicity; furthermore, we could not assess pemetrexed concentrations in the blood or urine as these assay techniques are not validated. Thus, care is needed when giving chemotherapy to patients with a neobladder.
Highlights
We describe a case of pemetrexed toxicities related to reabsorption by an ileal neobladder, which caused prolonged hematotoxicity and nephrotoxicity.Case presentation: A 59-year-old white man was diagnosed with metastatic wild-type adenocarcinoma of the upper lobe of his right lung
Pemetrexed may be reabsorbed by the ileal mucosa of the neobladder because of its hydrophobic structure and renal excretion in its active form
Published data excluded a potential role for cisplatin in this toxicity; we could not assess pemetrexed concentrations in the blood or urine as these assay techniques are not validated
Summary
Pemetrexed was the main cause of the adverse effects observed because of its absorption by the ileal neobladder, with this being exacerbated by our patient’s urinary retention. It was not possible to determine the plasma and urine concentrations of pemetrexed as these techniques are not routinely validated
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