The Management of Delayed Onset Cramps Related to Irinotecan during Oncological Treatment

Author(s): Jaques van Heerden, Nicolette Moes, Katleen Balliauw, Elien Romaen, Joris Verlooy, Machiel van den Akker, Koen Norga

Background: Irinotecan-induced gastro-intestinal side effects are well described in the literature. The pathophysiology and treatment of diarrhea, especially acute onset, is the most understood. Yet delayed onset cramps and management have not been sufficiently documented.

Materials: A case report of a nine-year-old girl diagnosed with rhabdomyosarcoma who was treated with irinotecan in the relapse setting, is presented. A limited literature review was done based on the challenges experienced during the management of a patient with delayed onset irinotecaninduced cramps. The pathophysiology of delayed onset irinotecan induced cramps is based on cholinergic, inflammatory and enzymatic factors as well as neural damage. Treatment was based on the etiology described in the literature with a positive result.

Conclusion: Delayed onset irinotecan related cramps are part of a multifactorial etiology that should be approached systematically, especially when first line treatment does not yield an adequate response.