Abstract YO10
Case summary
We present the case of a 42-year-old woman with a long-standing history of SLE and Class III lupus nephritis, who achieved remission with cyclophosphamide but developed CKD (baseline creatinine clearance 40 mL/min). In 2023, she was diagnosed with metastatic colon cancer, presenting with obstructive and constitutional symptoms. Imaging revealed an ascending colonic mass, mediastinal lymphadenopathies, and multiple lung and liver metastases.
The treatment intent was palliative, initiating FOLFOX chemotherapy with a 25% oxaliplatin dose reduction and standard anti-emetic premedication. Despite these measures, the patient experienced grade 3 chemotherapy-induced nausea leading to severe acute kidney injury (AKI) with metabolic acidosis. She presented on day 5 post-chemotherapy with confusion, lethargy, and reduced alertness, necessitating aggressive hydration and recovery to baseline within three days.
Subsequent FOLFOX chemotherapy, even with optimized anti-emetics and further dose reduction, resulted in similar complications. Nevertheless, due to improvement in liver enzymes and disease stabilization, chemotherapy was continued. Each session required prior hydration, nephrology consultation, chemotherapy administration, and post-chemotherapy hydration.
Molecular testing revealed KRAS wild type, allowing a switch to 5-FU chemotherapy combined with the anti-EGFR agent panitumumab. This regimen was less emetogenic and did not exacerbate kidney dysfunction. The patient’s disease responded positively, as evidenced by CEA monitoring and CT scan reassessment.
This case underscores the complexities of managing metastatic colon carcinoma in a patient with CKD secondary to lupus nephritis. Standard chemotherapy with moderate emetogenic potential posed significant challenges, impacting renal function. A personalized approach and a deeper understanding of nephro-oncology are warranted to optimize treatment in such patients.