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Objective: Unusual clinical course Background: Chemotherapy based on 5-fluorouracil (5-FU) is a well-established treatment for solid cancers, including metastatic or advanced colon cancer. Despite its efficacy, 5-FU can cause rare but serious adverse events such as acute neurotoxicity, which presents as symptoms similar to stroke. Case Report: We report the case of a patient who was diagnosed with stage IV colorectal cancer and who underwent chemotherapy with a high dose of 5-FU as part of the FOLFIRI (Folinic Acid, Fluorouracil, Irinotecan) treatment plan. During the seventh, eighth, and ninth cycles of chemotherapy, the patient suffered from severe encephalopathy, and the cause of this condition was determined to the 46-hour continuous intravenous infusion of 5-FU, which was part of the FOLFIRI regimen. Conclusions: 5-FU-induced hyperammonemic encephalopathy is a rare but serious adverse event that requires immediate recognition and treatment. The first step in managing this condition is to halt the 5-FU infusion and provide the patient with high volumes of fluid. Although most cases of 5-FU-induced encephalopathy resolve spontaneously, recurrence is possible if the drug is re-administered to the same patient. Therefore, it is crucial for healthcare providers to closely monitor patients receiving 5-FU chemotherapy and be aware of the signs and symptoms of hyperammonemic encephalopathy. Early intervention can prevent further complications and ensure the best possible outcome for the patient. It is important to note that while 5-FU-induced hyperammonemic encephalopathy is rare, it highlights the importance of closely monitoring patients receiving chemotherapy to identify and treat adverse events promptly. This can help improve patient outcomes and prevent serious long-term complications. [ABSTRACT FROM AUTHOR]

Background/Aim. Standard treatment options for the first-line treatment of metastatic colorectal carcinoma (mCRC) are 5-fluorouracil, folinic acid, oxaliplatin (FOL-FOX4)/capecitabine (CapOx), plus bevacizumab (bev) and 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) plus bev. The aim of this study was to compare overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with mCRC who were treated in the first line with FOLFIRI/bev vs. FOLFOX4/bev. At the same time, the aim was also to compare the safety profile in the observed groups of patients and to investigate optimal treatment duration and characteristics of patients who had the best treatment outcomes. Methods. The retrospective-prospective study included patients with mCRC treated with chemotherapy protocols for the first line in combination with bev (FOLFOX4/bev, respectively, FOLFIRI/bev). Treatment efficacy was evaluated on the basis of ORR, PFS, and OS, and the safety of treatment was evaluated by monitoring adverse drug reactions (ADR). Results. ORR was 70% in the FOLFIRI/bev group and 50% in the FOL-FOX4/bev group. Median PFS for FOLFIRI/bev (n = 30) and for FOLFOX4/bev (n = 30) was 15.6 months and 12.1 months, respectively [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.47–1.53; p = 0.5591]. Median OS for FOLFIRI/bev and for FOLFOX4/bev was 24.7 months and 19.9 months, respectively (HR 0.67; 95% CI 0.37–1.23; p = 0.1552). In both patient groups, the patients who received more than 9 cycles of induction therapy had better treatment response compared with patients who received less than 9 cycles of therapy. In the FOLFOX4/bev group, PFS was 16.9 vs. 9.7 months, and OS was 22.1 vs. 17.6 months, respectively. In the FOLFIRI/bev group, PFS was 9 months for patients who received less than 9 cycles of therapy vs. 18.8 months for patients who received more than 9 cycles, and OS was 18.0 months vs. 27.7 months, respectively. ADR grade 3 and 4 had 7% of the patients in the FOLFIRI/bev group vs. 27% in the FOLFOX4/bev group. Conclusion. Patients who received FOLFIRI/bev compared to those treated with FOLFOX4/bev had better ORR (70% vs. 50 %, respectively), PFS (15.6 months vs. 12.1 months, respectively), and OS (24.7 months vs. 19.9 months, respectively). In both patient groups, the patients who received induction therapy for 4–6 months (more than 9 cycles of therapy) had a better treatment response.

The combination chemotherapy of irinotecan with 5-fluorouracil and leucovorin (FOLFIRI regimen) was recently proven to be beneficial in patients with advanced colorectal cancer. Pulmonary toxicity is very rare in adverse effects of irinotecan. No case of organizing pneumonia (also known as bronchiolitis obliterans organizing pneumonia) associated with FOLFIRI chemotherapy has been reported. We experienced a case of a 62-year-old man who presented persistent dry cough and progressive dyspnea after receiving chemotherapy with FOLFIRI regimen. After surgical lung biopsy, the patient was diagnosed with FOLFIRI chemotherapy-induced organizing pneumonia which was successfully treated with steroid therapy.