Autonomic Dysfunction Induced by Single Cycle Combination Therapy with Paclitaxel-Cisplatin

Nithisha Thatikonda^1, and Merry Chen²

¹Department of Neurology, University of Texas Medical Branch Galveston, Texas

²Department of Neuro Oncology, MD Anderson Cancer Centre, Texas

Cite this paper:
Nithisha Thatikonda and Merry Chen. Autonomic Dysfunction Induced by Single Cycle Combination Therapy with Paclitaxel-Cisplatin. American Journal of Medical Case Reports. 2024; 12(5):78-80. doi: 10.12691/ajmcr-12-5-3

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) involving the autonomic nervous system (ANS) is frequently reported in the literature next to somatic sensory neuropathies. A few chemotherapy agents, such as platinum-based compounds and taxanes, are known to cause dose-dependent cumulative neurotoxicity, wherein autonomic symptoms develop gradually throughout treatment. However, when these chemotherapeutic agents are administered together as a part of a chemotherapy regimen, possible synergistic neurotoxicity is anticipated, even with a single course of treatment. We described a patient who developed severe autonomic dysfunction resulting in neurogenic orthostatic hypotension (nOH) and paralytic ileus after receiving only a single course of paclitaxel-ifosfamide-cisplatin (TIP) regimen for recurrent testicular cancer. The patient was bedridden for six weeks with slow recovery and remained with nOH for three months after discharge. Monitoring ANS parameters (blood pressure, heart rate, and their alterations upon standing) and timely identification of autonomic dysfunction is crucial to introducing treatment modifications/cessations accordingly.

Keywords:
nocturnal orthostatic hypotension autonomic dysfunction cisplatin paclitaxel

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