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Thiamine deficiency in a patient with recurrent renal cell carcinoma who developed weight loss with normal appetite and loss of energy soon after nivolumab treatment

Published online by Cambridge University Press:  19 September 2019

Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window] ,
Takashi Okabe ,
Nozomu Uchida ,
Suguru Shirotake ,
Maki Todo ,
Masafumi Oyama  and
Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window]
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Takashi Okabe
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Suguru Shirotake
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Maki Todo
Affiliation:
Department of Pharmacy, Saitama Medical University International Medical Center, Saitama, Japan
Masafumi Oyama
Affiliation:
Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama350-1298, Japan. E-mail: honishi@saitama-med.ac.jp
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Abstract

Background

Nivolumab has become an effective treatment option for cancer in various sites; however, this drug may cause immune-related adverse effects due to its mechanism of action. Furthermore, little has been reported on thiamine deficiency (TD) in patients receiving nivolumab treatment.

Method

From a series of cancer patients, we reported a patient with recurrent renal cell carcinoma who developed TD after the start of nivolumab treatment.

Results

A 74-year-old man with recurrent renal cell carcinoma was referred to the psycho-oncology department as he had lost about 4 kg and displayed a loss of energy after four cycles of nivolumab treatment. Psychiatric interviews revealed a decrease in energy. Neurological examination did not reveal any impairment in consciousness, ataxia, or ocular symptoms. He did not develop appetite loss. The malabsorption or overconsumption of some nutrients is thought to occur due to the rapid loss of weight; thus, a reduction in vitamin B1, which has a short storage period in the body and is often deficient in cancer patients, was suspected. The diagnosis of TD was supported by the patient's abnormally low serum thiamine level.

Significance of results

In patients treated with nivolumab, it is necessary to pay careful attention to TD when proceeding with the treatment. It is hoped that future research may reveal the link between nivolumab administration and TD.

Keywords

CancerNivolumabThiamine deficiencyWernicke encephalopathy
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 241 - 243
Copyright
Copyright © Cambridge University Press 2019

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