Gangguan Neuropsikiatri Paska Kemoterapi Ifosfamid
DOI:
https://doi.org/10.36408/mhjcm.v8i1.575Keywords:
Ifosfamid, neuropsikiatri, neurotoksisitas, kloroasetaldehidAbstract
Latar belakang: Reaksi obat yang merugikan (adverse drug reaction) sering muncul salah satunya pada obat-obat sitostatika. Ifosfamid adalah obat sitostatika golongan pengalkil yang ketika dimetabolisme akan membentuk senyawa aktif nitrogen mustard sitotoksik. Selain itu ia juga membentuk senyawa lain yaitu akrolein dan kloroasetaldehid. Akrolein yang bersifat urotoksik ini dengan mudah akan diikat oleh mesna, sedangkan kloroasetaldehid bersifat neurotoksik yang hingga sampai saat ini masih menjadi masalah karena keterbatasan panduan untuk anti dotumnya.
Kasus: Kami mendeskripsikan 3 pasien dengan diagnosis berbeda yang mengalami gangguan neuropsikiatri paska kemoterapi ifosfamid yaitu kanker saluran empedu dengan mengantuk berat, kanker ovarium residif dengan halusinasi, dan tumor ganas pelvis dengan penurunan kesadaran disertai kejang.
Pembahasan: Gangguan neuropsikiatri dapat disebabkan oleh neurotoksisitas dari hasil metabolisme dari ifosfamid yaitu kloroasetaldehid yang secara langsung maupun tidak langsung merusak neuron (neurotoksik). Manifestasi klinisnya dapat bertingkat mulai dari kebingungan dan mengantuk hingga kejang, koma dan kematian. Onset munculnya gejala terutama hitungan jam hingga 2 hari setelah kemoterapi selesai. Terdapat faktor resiko munculnya neurotoksisitas yang teridentifikasi pada laporan kasus ini yaitu gangguan fungsi ginjal dan hipoalbumin. Beberapa penelitian mengatakan bahwa toksistas ini berifat reversible, demikian juga dengan pasien kasus pertama yang membaik setelah 24 jam, dan kasus kedua yang membaik setelah 5 hari, namun pemberian terapi spesifik tetap direkomendasikan pada NCI stadium III atau IV.
Kesimpulan: Gangguan neuropsikiatri paska kemoterapi ifosfamid dapat disebabkan oleh neurotoksisitas pada SSP akibat kloroasetaldehid dengan faktor resiko yaitu gangguan fungsi ginjal dan hipoalbumin. Diperlukan penelitian lebih lanjut untuk memastikan bahwa gejala neuropsikiatri yang muncul adalah murni karena ifosfamid, misalnya dengan melakukan pengukuran kadar obat di dalam darah.
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