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Alarcón-Barrios S, Luvián-Morales J, Castro-Eguiluz D, Delgadillo-González M, Lezcano-Velázquez BO, Arango-Bravo EA, Flores-Cisneros L, Aguiar Rosas S, Cetina-Pérez L. Chemoradiotherapy treatment with gemcitabine improves renal function in locally advanced cervical cancer patients with renal dysfunction. Curr Probl Cancer 2024; 48:101041. [PMID: 37988902 DOI: 10.1016/j.currproblcancer.2023.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Cervical cancer (CC) in Mexico is diagnosed mainly in locally advanced (LACC) and advanced (ACC) stages, where ureteral obstruction is more frequent. The standard treatment for this population is concurrent chemoradiotherapy (CCRT) with cisplatin, which is nephrotoxic and could lead to further deterioration of renal function in LACC patients with renal function decline. We aimed to evaluate the effect of CCRT with Gemcitabine on renal function in LACC patients. METHODS This retrospective study included LACC patients treated with CCRT with Gemcitabine as a radiosensitizer from February 2003 to December 2018. Data were collected from medical archives and electronic records. We assessed renal function before and after CCRT treatment and analyzed the patient's response to treatment and survival. RESULTS 351 LACC patients treated were included and stratified into two groups: 198 with Glomerular Filtration Rate (GFR) ≥60ml/min (group A) and 153 with GFR<60ml/min (group B). An improvement in GFR was observed after CCRT in patients in group B, from 33 ml/min to 57.5 ml/min (p<0.001). Complete response was observed in 64.1% of patients in Group A and 43.8% in Group B (p<0.0001). Factors associated with increased risk of death included having a GFR of 15-29 ml/min (HR: 2.17; 1.08-4.35), having GFR<15 ml/min (HR: 3.08; 1.63-5.79), and receiving Boost treatment (HR: 2.09; 1.18-3.69). On the other hand, receiving brachytherapy is a positive predictor for OS (HR:0.51; 0.31-0.84). CONCLUSION CCRT with gemcitabine is an appropriate treatment option for patients diagnosed with LACC who present impaired renal function due to the disease's obstructive nature or other comorbidities.
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Affiliation(s)
- Silvia Alarcón-Barrios
- Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, México; MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Julissa Luvián-Morales
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT) Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Merari Delgadillo-González
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Brenda Olivia Lezcano-Velázquez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eder Alexandro Arango-Bravo
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Sebastián Aguiar Rosas
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Lucely Cetina-Pérez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Aloy B, Janus N, Isnard-Bagnis C, Deray G, Launay-Vacher V. [Renal toxicity of anticancer drugs]. Nephrol Ther 2021; 17:553-563. [PMID: 34802974 DOI: 10.1016/j.nephro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The renal toxicity of anticancer drugs is a clinical challenge because of the intrinsic toxicity of some anticancer drugs and because the cancer itself. Indeed, cancer patients are exposed to all types of renal disorders (obstructive, functional, organic because of radiotherapy, paraneoplastic glomerulopathy, thrombotic microangiopathy…). The therapeutic index of anticancer drugs is often narrow and the doses used for optimal efficacy are high. Improving safety requires a better dose adjustment, which depends on the correct evaluation of the renal function. Prevention remains important as the mortality associated with acute renal failure is very high.
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Affiliation(s)
- Blandine Aloy
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 83, boulevard de l'Hôpital, 75013 Paris, France; Service information conseil adaptation rénale (Icar), cour des consultations porte 12, hôpital Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Nicolas Janus
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 83, boulevard de l'Hôpital, 75013 Paris, France; Service information conseil adaptation rénale (Icar), cour des consultations porte 12, hôpital Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Cancer and the Kidney International Network, boulevard du Souverain, 280, 1160 Bruxelles, Belgique
| | - Corine Isnard-Bagnis
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 83, boulevard de l'Hôpital, 75013 Paris, France; Campus Pierre-et-Marie-Curie, Sorbonne Université, 4, place Jussieu, 75005 Paris, France
| | - Gilbert Deray
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 83, boulevard de l'Hôpital, 75013 Paris, France; Service information conseil adaptation rénale (Icar), cour des consultations porte 12, hôpital Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Cancer and the Kidney International Network, boulevard du Souverain, 280, 1160 Bruxelles, Belgique; Campus Pierre-et-Marie-Curie, Sorbonne Université, 4, place Jussieu, 75005 Paris, France
| | - Vincent Launay-Vacher
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 83, boulevard de l'Hôpital, 75013 Paris, France; Service information conseil adaptation rénale (Icar), cour des consultations porte 12, hôpital Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Cancer and the Kidney International Network, boulevard du Souverain, 280, 1160 Bruxelles, Belgique
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Luo HL, Liu HY, Chang YL, Su YL, Huang CC, Lin XJ, Chuang YC. Extracorporeal Shock Wave Enhances the Cisplatin Efficacy by Improving Tissue Infiltration and Cellular Uptake in an Upper Urinary Tract Cancer Animal and Human-Derived Organoid Model. Cancers (Basel) 2021; 13:cancers13184558. [PMID: 34572785 PMCID: PMC8471724 DOI: 10.3390/cancers13184558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Upper urinary tract urothelial carcinoma (UTUC) is a relatively rare cancer with a poor prognosis if diagnosed at an advanced stage. Although cisplatin-based chemotherapy is a common treatment strategy, it has a limited response rate. Shock wave lithotripsy is a common treatment for upper urinary tract stones. Low-energy shock waves (LESWs) temporarily increase tissue permeability and enhance drug penetration to the targeted tissue. However, no study has investigated the efficacy of the combination of shock wave lithotripsy and chemotherapy in UTUC. Hence, in this study, we aimed to identify the potential application of the combination of LESW and chemotherapy in UTUC. We evaluated the synergistic effects of LESW and cisplatin in vitro, in vivo, and in patient-derived organoid (PDO) models. Compared with cisplatin alone, the combination treatment caused more significant tumour suppression in vitro and in animal models, without increased toxicity. Histological examination showed that compared with animals treated with cisplatin alone, those who received the combination treatment showed more deteriorated cell arrangement and cell oedema. Moreover, LESW improved the cytotoxicity of cisplatin in the preclinical PDO model of UTUC. Thus, LESW combined with cisplatin is a potential new antitumour strategy for improving the treatment response in locally advanced UTUC.
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Affiliation(s)
- Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hui-Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
| | - Yin-Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
| | - Yu-Li Su
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Xin-Jie Lin
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8094); Fax: +886-7-7354309
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