Tardive Akathisia in an Adult on Long Term Metoclopramide

Metoclopramide is prescribed to subjects dealing with gastrointestinal issues like delayed gastric emptying, nausea, vomiting or loss of appetite. It is also used to treat chemotherapy and surgery related nausea and vomiting. Although it is very effective in targeting stomach related illnesses, severe adverse drug reactions can occur in those who take metoclopramide. This case report describes a 32-year-old female who suffered from tardive akathisia while being treated with long-term metoclopramide. Long term exposure to causative medication leads to evolution of Tardive akathisia and this can stay for a lifetime. It is important to restrict the exposure duration of triggering drug. Health care professionals and patients should be well aware of this neurological adverse event of metoclopramide.

Sustained Stable Disease with Capecitabine plus Bevacizumab in Metastatic Appendiceal Adenocarcinoma: A Case Report

In a patient who had been diagnosed in 2006 with appendiceal adenocarcinoma with peritoneal metastases after an incomplete surgery, palliative chemotherapy was administered. First-line treatment with 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX) and second-line treatment including 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) plus panitumumab showed inefficiency in controlling disease progression. Third-line chemotherapy combining capecitabine plus bevacizumab was started, achieving good control of the tumour growth and a minor response in the second computed tomography scan. We decided to maintain the treatment, although forced bevacizumab “breaks” were necessary due to unexpected adverse events, with the patient suffering disease progression every time bevacizumab was stopped and reaching minor response again once the antiangiogenic treatment was reintroduced. During more than 10 years after starting third-line treatment, the patient maintained good performance status and disease stability with this “up and down” management until January 2019, when a neurological adverse event during bevacizumab infusion drove us to abandon it definitely.

An Overview of Chemotherapy-Induced Peripheral Neuropathy

Peripheral neuropathy remains a major limitation of chemotherapeutic agents used in cancer treatment. This neurologic complication from chemotherapy occurs frequently and can be debilitating. Although difficult to predict, both chemotherapeutic and patient-specific risk factors may contribute to this adverse event. Symptoms of peripheral neuropathy may appear acutely after treatment or persist chronically upon drug discontinuation. The taxanes, vinca alkaloids, and immunomodulatory drugs commonly cause peripheral nervous system toxicity. Prompt recognition and evaluation of this neurological adverse event by those who provide care to patients with cancer can prove to have a positive impact on the quality of life of those patients.