Friday, April 29, 2011

Taxanes and Neutropenic Colitis


One of the dreaded complications of taxane-based chemotherapy agents is severe neutropenic colitis. The images above are pretty classic. Mortality rates approach 50%. Surgical treatment is usually an ileocolectomy with an ileostomy. When I saw this particular patient, there wasn't much to be done. He had extensive mottling of his legs and abdominal wall and, hemodynamically, he was already starting to crash. (As an aside, mottling is one of the most ominous random clinical findings you can encounter. The bluish-black stippling of the skin is an imprint of death itself.

3 comments:

Anonymous said...

Oh dear. My friend is going to be starting chemo for breast ca soon, not sure yet if Taxol will be in the regime, I'll be taking her to treatments.

What are the early signs of this colitis? I take it this poor guy was showing the late signs. Had his neutropenia already been caught or did he present with colitis?

The incidence is probably way under 1% but my friend has a knack for reacting badly to medications. And a knack for not wanting to bother people.

Cheryl said...

Dr Parks:My best friend of at least 55yrs died in San Diego a few days ago of neutropenic colitis. She was diagnosed in Jan. 11' with stage 2 breast cancer. She had a single mastectomy and there was no cancer found in lymph nodes. She was 64 and in good health otherwise. She was hospitalized for approx 24 days before she died from her insides being fried by the chemo. She had a team of 13 Drs trying to save her life to no avail. They said they had NEVER seen this kind of reaction in anybody in their entire careers. She was on dialysis because she had not passed any urine in 14 days. I don't blame the Drs but it makes me so angry because she died needlessly when her chances for full recovery were very very good! How could this happen? Her name is Marsha J. Ventittelli and she died in San Diego probably on the 17th, 18th or 19th of May 2011. I don't know which hospital as I live in Ariz and when I called her husband (Rocky) I forgot to ask the exact day she died. Perhaps you could find out more details and let me know. I would appreciate any info you have on the condition and possibly you could find out the hospital and talk to her oncologist. (in your spare time, ha-ha) You can contact me at cahld6@gmail.com Thank you so much in advance for any light you can shed on this terrible tragedy. Sincerely, Cheryl Holderby

TEtech said...

Dear Dr.,
Thanks for your informative blog.
What is the rate of death from sepsis after the first dose of Taxoter? I suspect it is much higher than a few %, as this just happened to a healthy prostate cancer patient.
I would also like to know the early signs of infection leading to sepsis.