Case Series of Irinotecan-Induced-Dysarthria: A Review of Literature and Proposition of a Pre-Medication Regimen

Irinotecan is a topoisomerase-I inhibitor that is commonly used in combination with other chemotherapy agents for gastrointestinal malignancies. It has been found to induce transient dysarthria during infusion which has prompted premature cessation. We encountered 3 patients on FOLFIRINOX who experienced dysarthrialike symptoms during irinotecan infusion. Through a literature review and prospective observational study done at our tertiary care facility, we devised a pre-medication regimen which included extending the irinotecan infusion to 3 hours, replacement of all electrolytes to the upper limits of normal and the addition of atropine during infusion. These steps were to be taken in addition to the standard pre-medications to prevent known side effects of nausea, diarrhea and cholinergic syndrome. During subsequent irinotecan infusion sessions for our 3 patients, we exposed them to our proposed pre-medication regimen which resulted in toleration of therapy and dysarthria-free or significant attenuation of symptoms. The purpose of this case series is to promote further awareness of this unusual reaction as well as to propose a standard pre-medication regimen with all subsequent irinotecan administrations in the event a patient develops dysarthria on initial therapy.