Optimized Strategies Needed for TLS Prevention, Intervention in SCLC

Optimized strategies for preventing and managing acute tumor lysis syndrome (ATLS) in patients with small cell lung cancer (SCLC) are needed, warn researchers of a newly published case study they say illustrates the complicated nature of managing this life-threatening complication.¹

While patients with SCLC typically face a low risk of acute TLS (ATLS) overall, they’re considered a high-risk group within the context of solid tumors, explained the researchers. The risk of TLS is typically highest among patients with hematologic malignancies, such as acute lymphoblastic leukemia. The complication, brought on by rapid breakdown of cancer cells, causes the release of intracellular contents into the bloodstream, causing heart and kidney problems.²

Considering the life-threatening risk of TLS, the researchers underscored the importance of identifying patients at particular risk of the complication. | Image credit: mi_viri - stock.adobe.com

Early and intensive intervention of TLS is crucial; however, even with aggressive treatment, TLS can remain life-threatening. In the case study detailed in the International Journal of Emergency Medicine, researchers outlined their TLS case, which persisted and resulted in death despite rapid intervention among an older male with newly diagnosed SCLC.¹

“This case highlights the complexity and challenges in managing ATLS in SCLC patients with high tumor burden and high proliferation following first-line chemotherapy. It serves as a reminder for clinicians about the importance of early recognition, aggressive intervention, and personalized preventive strategies tailored for high-risk patients, though such measures may not necessarily improve clinical outcomes in cases of ATLS,” wrote the researchers, adding the importance of both providers and patients understanding the risks of ATLS.

In the case study, the 74-year-old male patient developed ATLS 2 days after initiation of chemotherapy, despite a personalized epirubicin and cyclophosphamide regimen and intensive supportive care implemented. Diagnosed with stage 4 SCLC and multiple metastases, the patient had several factors, including a large tumor burden, rapid progression of his disease, and both liver and kidney dysfunction, that designated him as high-risk of TLS.

Prior to starting his chemotherapy regimen, the patient received aggressive interventions to improve liver and kidney function as well as hydration and urine alkalinization with monitoring—standard TLS prevention measures. After developing TLS, the patient’s condition continued to decline despite intensive monitoring, diuretics, and interventions to reduce uric acid. A day later, the patient passed away as a result of TLS-associated imbalances in electrolytes.

A systematic review of similar cases over the last 50 years showed similar outcomes, emphasizing the high risk of rapid progression and mortality associated with TLS. Nine of the 17 patients in the reported cases passed away shortly after the onset of the complication.

Among these reported cases, onset of TLS occurred within 1 to 7 days of treatment initiation. The review also highlighted the possibility of TLS risk in treatment-naïve patients, as approximately half (n = 8) of the cases were spontaneous.

Considering the life-threatening risk of TLS, the researchers underscored the importance of identifying patients at particular risk of the complication. Kidney and bone metastases are among the factors that have been linked to TLS.

“Advanced age is another critical risk factor for this oncologic emergency,” explained the group. “In our case, the 74-year-old patient belonged to a high-risk group. Based on previous reports, elderly patients frequently exhibit significant renal dysfunction and metabolic derangements, which may contribute to disease progression and poorer clinical outcomes.”

References:

1. Han Y, Yue P, Yuan Z. Small cell lung cancer case report: acute tumor lysis syndrome after chemotherapy and management strategies for high-risk patients. Int J Emerg. Published online April 2, 2025. doi:10.1186/s12245-025-00879-3
2. Adeyinka A, Kaur A, Bashir K. Tumor lysis syndrome. National Library of Medicine. Last updated October 5, 2024. Accessed April 17, 2025. https://www.ncbi.nlm.nih.gov/books/NBK518985/