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Full-dose cisplatin chemotherapy combined with hemodialysis in a patient with impaired renal function and a mediastinal germ cell tumor. Anticancer Drugs 2021; 31:983-987. [PMID: 32011365 DOI: 10.1097/cad.0000000000000911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cisplatin is the first choice treatment in mediastinal germ cell tumors. However, concerns regarding increased toxicity of cisplatin hamper its administration in patients with impaired renal function. We describe a 42-year-old man with chronic kidney disease stage 4 who was diagnosed with a mediastinal germ cell tumor and metastases in lung and brain. Treatment with cisplatin-etoposide was considered essential for a chance of cure. In order to administer the full cisplatin dose, 4-hour hemodialysis sessions were performed after each cisplatin infusion. During treatment cycle 3, 4 and 5, total and unbound plasma platinum concentrations were measured. Trough concentrations and half-life were at the higher end of the range of those observed in patients with adequate renal function who received the same dose of cisplatin. Hemodialysis aided platinum clearance, although our patient was also able to clear some platinum by his own renal function. With this full dose treatment, our patient obtained a favorable tumor response, with a strong decrease of beta-human chorionic gonadotropin and tumor size. The side effects experienced by our patient were serious, although not worse than what could be expected with this type of treatment. His renal function remained stable during the treatment period.
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Jiang DM, Gupta S, Kitchlu A, Meraz-Munoz A, North SA, Alimohamed NS, Blais N, Sridhar SS. Defining cisplatin eligibility in patients with muscle-invasive bladder cancer. Nat Rev Urol 2021; 18:104-114. [PMID: 33432181 DOI: 10.1038/s41585-020-00404-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/29/2023]
Abstract
The current treatment paradigm for muscle-invasive bladder cancer (MIBC) consists of cisplatin-based neoadjuvant chemotherapy followed by local definitive therapy, or local definitive therapy alone for cisplatin-ineligible patients. Given that MIBC has a high propensity for distant relapse and is a chemotherapy-sensitive disease, under-utilization of chemotherapy is associated with suboptimal cure rates. Cisplatin eligibility criteria are defined for patients with metastatic bladder cancer by the Galsky criteria, which include creatinine clearance ≥60 ml/min. However, consensus is still lacking regarding cisplatin eligibility criteria in the neoadjuvant, curative MIBC setting, which continues to represent a substantial barrier to the standardization of patient care and clinical trial design. Jiang and colleagues accordingly suggest an algorithm for assessing cisplatin eligibility in patients with MIBC. Instead of relying on an absolute renal function threshold, their algorithm emphasizes a multidisciplinary and patient-centred approach. They also propose mitigation strategies to minimize the risk of cisplatin-induced nephrotoxicity in selected patients with impaired renal function. This new framework is aimed at reducing the inappropriate exclusion of some patients from cisplatin-based neoadjuvant chemotherapy (which leads to under-treatment) and harmonizing clinical trial design, which could lead to improved overall outcomes in patients with MIBC.
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Affiliation(s)
- Di Maria Jiang
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shilpa Gupta
- Department of Hematologic and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Abhijat Kitchlu
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Meraz-Munoz
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott A North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nimira S Alimohamed
- Department of Medicine, Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Normand Blais
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal; Université de Montréal, Montreal, Quebec, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Morita-Ogawa T, Sugita H, Minami H, Yamaguchi T, Hanada K. Population pharmacokinetics and renal toxicity of cisplatin in cancer patients with renal dysfunction. Cancer Chemother Pharmacol 2020; 86:559-566. [PMID: 32949266 DOI: 10.1007/s00280-020-04147-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The pharmacokinetics (PKs) of cisplatin have not been investigated in patients with renal dysfunction, characterized by creatinine clearance (Ccr) < 60 mL/min. In this study, we performed a population pharmacokinetic (PPK) analysis of unchanged cisplatin in patients with renal dysfunction. We investigated the effects of renal dysfunction on the PKs and nephrotoxicity of unchanged cisplatin. METHODS We enrolled 23 patients with moderate renal dysfunction (Ccr calculated to be 30-60 mL/min using the Cockcroft-Gault formula) treated with cisplatin. PPK analysis was performed by nonlinear mixed effect modeling using NONMEM (Version 7.2). We evaluated gender, age, body surface area (BSA), weight, baseline Ccr, baseline serum creatinine (Scr), and baseline urea nitrogen as potential covariates. The final model was evaluated using bootstrap analysis. Renal toxicity was evaluated using Common Terminology Criteria for Adverse Events ver. 4.0. The frequency of severe renal dysfunction (Grade 3/4 Scr elevation) was measured in the population. RESULTS A one-compartment model adequately described the unchanged cisplatin data. The population mean values for clearance (CLtot) and volume of distribution (Vd) were 19.1 L/h [coefficient of variation (CV) 19.4%] and 13.8 L (CV 41.0%), respectively. The final model identified BSA as a significant covariate for CLtot. There were no significant covariates for Vd. No patients suffered from severe nephrotoxicity to the point that hemodialysis was required. CONCLUSION Moderate renal dysfunction does not affect the PKs of unchanged cisplatin. The increased serum concentration of cisplatin may not lead to increased toxicity in patients with renal dysfunction. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION UMIN000007091 (January 17, 2012).
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Affiliation(s)
- Tomoko Morita-Ogawa
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan.
| | - Hiroki Sugita
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Hyogo, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuhiko Hanada
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
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Two cases of cisplatin-induced permanent renal failure following neoadjuvant chemotherapy for esophageal cancer. Int J Surg Case Rep 2016; 20:63-7. [PMID: 26851395 PMCID: PMC4818298 DOI: 10.1016/j.ijscr.2016.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Abstract
Two esophageal cancer patients developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. Volume expansion remains the most effective strategy for prevention of cisplatin nephrotoxicity. The two patients described here received sufficient drip infusion and produced good urine volumes. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover.
Introduction We experienced two esophageal cancer patients who developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. Presentation of case After administration of cisplatin, their serum creatinine increased gradually until they required hemodialysis and their renal failure was permanent. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover. After these events, one patient underwent definitive radiotherapy and the other underwent esophagectomy for their esophageal cancers, while continuing dialysis. Both patients are alive without cancer recurrence. Discussion In these two cases of cisplatin-induced renal failure, renal biopsy examination showed only slight disorder of proximal tubules and tendency to recover. Conclusion Although cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure.
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Ahmadzadeh A, Shahbazian H, Safapour N, Tulabi M, Zandifar S. Comparison between the effects of one-day treatment regimen with cisplatin on renal function and various biochemical parameters in patients with gastric and lung cancer compared with two-days divided cisplatin treatment regimen. J Renal Inj Prev 2015; 4:87-91. [PMID: 26468480 PMCID: PMC4594219 DOI: 10.12861/jrip.2015.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cisplatin is an efficient chemotherapeutic drug used for the treatment of different cancers. Clinical trials represents cisplatin-induced nephrotoxicity in a dose dependent manner.
Objectives: This study aimed to compare the effects of 1-day treatment regimen with cisplatin on renal function, potassium, calcium, magnesium and uric acid in patients with gastric and lung cancer compared with 2-day divided cisplatin treatment regimen to suggest appropriate management for decrease nephrotoxic effects and >electrolyte abnormalities.
Patients and Methods: The study was conducted as a randomized clinical trial. The sample consisted of 60 patients with gastric and lung cancer treated with cisplatin in Ahvaz Shafa hospital. Patients were randomly divided into 2 equal groups. Both groups were treated with cisplatin over a period of 6 to 18 weeks. The first group received 50 mg/m2/day of cisplatin during one day and the second group received 25 mg/m2/day in 2 days. Electrolytes in each period and renal function at baseline and 6 months after starting treatment was assessed.
Results: Difference of mean of renal function and nephrotoxicity incidence in the 2 groups was statistically significant. The odds of hypokalemia in 1-day group was higher than 2-day group (odds ratio [OR] = 6.5), which was statistically significant. However there was no significant relationship between the types of treatment and the risk of hypocalcemia, hypomagnesemia and hyperuricemia.
Conclusion: The result of this study showed that, the divided administration of cisplatin reduces the nephrotoxic and hypokalemia effects of this drug, however it had not significant influence on hypomagnesemia, hypocalcaemia, and hyperuricemia.
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Affiliation(s)
- Ahmad Ahmadzadeh
- Department of Hematology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Heshmatollah Shahbazian
- Chronic Kidney Disease Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Safapour
- Department of Hematology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehri Tulabi
- Department of Hematology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sepideh Zandifar
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lacava V, Coppolino G, Puntorieri E, Cernaro V, Lupica R, Visconti L, Buemi A, Santoro D, Buemi M. Nephro-oncology: a link in evolution. Ren Fail 2015. [PMID: 26211500 DOI: 10.3109/0886022x.2015.1068514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A multidisciplinary approach represents the best method to interact with patients. Neoplastic and renal diseases are closely related to each other because of an increased risk of cancer among individuals with end-stage renal disease and because of the high prevalence of renal failure in cancer patients. Physicians should be able to know how to prevent and treat the possible complications which may appear during the course of neoplastic disease that may lead to kidney damage such as the Acute Tumor Lysis Syndrome, disorders of hydroelectrolitic balance, metabolic alterations in the calcium-phosphorus, anemia, interstitial and glomerular impairment due to chemotherapy. It is very important to know patients' renal function and directly monitor it, before and during treatment, using formulas for estimating glomerular filtration rate (GFR) and above all, specific biomarkers are more early and sensitive than the increase of creatinine, like neutrophil gelatinase-associated lipocalin. Additionally, physician should consider that alteration of GFR or substitutive renal treatments severely influence dosage of tumor markers and it could lead to wrong diagnosis of cancer. The aim of this article is to provide a review of problems related to cancer relevant in the development of renal failure and try to define the best therapeutic strategies to cope with possible kidney imbalances induced by cancer or its treatment.
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Affiliation(s)
- Viviana Lacava
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Giuseppe Coppolino
- b Nephrology and Dialysis Unit, University Hospital Magna Graecia of Catanzaro , Catanzaro , Italy , and
| | - Elvira Puntorieri
- c Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension Unit, CNR National Research Council , Reggio , Calabria , Italy
| | - Valeria Cernaro
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Rosaria Lupica
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Luca Visconti
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Antoine Buemi
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Domenico Santoro
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Michele Buemi
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
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