Abstract
Modified FOLFOX6 (mFOLFOX6) therapy has been widely used for unresectable advanced recurrent colorectal cancer as a standard regimen, however, there have been few cases reporting hyperammonemia and coma as adverse events of the therapy. No consensus has been obtained as to the following regimen for colorectal cancer when the patients develop hyperammonemia.
We have experienced a case of sigmoid colon cancer with multiple hepatic metastases in which the patient developed hyperammonemia and coma after the introduction of mFOLFOX6 therapy. So far clinical cases have been reported in which authors selected to reduce the dose of 5-FU, to change to another therapy that did not include 5-FU, or to discontinue any therapies as the following regimen. In our case, we could introduce and sustain CapeOX therapy while the blood ammonia level had been monitoring. Compared to mFOLFOX6 therapy in which 5-FU is administered during a relatively short time, CapeOX therapy permits to administer oral fluoropyrimidines for 14 days. So CapeOX therapy might be a treatment of choice as the following regimen for patients who have developed hyperammonemia due to 5-FU. Further studies can be expected.
