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Neuron-Specific Enolase as a Biomarker in Ifosfamide-Induced Encephalopathy: A Case Report
Arthur Claessens1, Agathe Manchart1, Mahira Boufraine1
1Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.
Introduction:
Ifosfamide, an alkylating agent, is used in treatment of various malignancies and may cause encephalopathies. The pathophysiology of this treatment adverse event is well documented, complex, and multifactorial, and involves the production of drug-related metabolites interfering with the normal functionality of neuronal synapses. Risk factors associated with the development of ifosfamide-induced encephalopathy have been identified including concurrent cisplatin administration and female gender. The clinical symptoms vary, ranging from simple confusion to seizure or coma. To date, no biomarkers have been evaluated in ifosfamide-induced encephalopathy. Neuron-specific enolase (NSE) elevation has already been correlated within toxic or metabolic encephalopathies regardless of the underlying etiology.
Case Presentation:
We report the case of a 56-year-old woman who received adjuvant chemotherapy for high-grade osteosarcoma including cisplatin, doxorubicin, and ifosfamide. The patient experienced ifosfamide-induced encephalopathy the day after completion of the ifosfamide infusion protocol. Treatment with methylene blue was initiated as soon as confusion developed. The patient presented behavioral problems, cognitive impairment, agitation, and aphasia, which resolved within few days, with persistent fatigue. NSE levels were assessed after every electroencephalogram (EEG). The kinetics of NSE levels from 20.41 to 7.69 µg/L and EEG toxic pattern improving from grade 2 to normal were consistent with recovery from clinical encephalopathy in this patient.
Conclusion:
Although increased levels of NSE in peripheral blood have been correlated with other etiologies of encephalopathy, its use as a companion biomarker for ifosfamide-induced encephalopathy warrants further investigation.
Insights
This study highlights neuron-specific enolase (NSE) as a potential biomarker for ifosfamide-induced encephalopathy. Monitoring NSE levels alongside EEG may aid in assessing patient recovery from this chemotherapy side effect.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Ifosfamide is an alkylating agent used in cancer treatment that can cause encephalopathy.
- The exact pathophysiology involves drug metabolites affecting neuronal synapses, with risk factors including cisplatin and female gender.
- Currently, no specific biomarkers are established for ifosfamide-induced encephalopathy.
Observation:
- A case of a 56-year-old woman with osteosarcoma treated with ifosfamide, cisplatin, and doxorubicin is presented.
- The patient developed ifosfamide-induced encephalopathy with symptoms including confusion, cognitive impairment, and agitation.
- Treatment with methylene blue was initiated, and neuron-specific enolase (NSE) levels were monitored.
Findings:
- NSE levels decreased from 20.41 to 7.69 µg/L.
- Electroencephalogram (EEG) patterns improved from grade 2 toxic to normal.
- The normalization of NSE levels and EEG correlated with clinical recovery from encephalopathy.
Implications:
- Neuron-specific enolase (NSE) shows promise as a companion biomarker for ifosfamide-induced encephalopathy.
- Further research is needed to validate NSE's role in monitoring this specific type of chemotherapy-related neurological toxicity.
- This finding could lead to improved diagnostic and monitoring strategies for patients receiving ifosfamide.
