Correlation Between Higher Cumulative Dose of Cisplatin for Concurrent Chemoradiation and Acute Kidney Disease Incidence Among Nasopharyngeal Carcinoma Patients: A Comparative Study

Abstract

Introduction Nasopharyngeal carcinoma (NPC) is the most malignant cancer in the head and neck area. According to the stage, the management of NPC includes radiation, chemotherapy, or a combination of both. The standard agent for radiosensitizing chemotherapy is cisplatin. Among the several effects of cisplatin administration, nephrotoxicity raises the most concern, especially in high doses. Acute kidney disease (AKD) is a condition in which an acute kidney injury occurs at >7 days but <90 days. This study aimed to assess whether there is a significant difference in the incidence of AKD between NPC patients who received a cumulative dose of cisplatin up to (≤) 200 mg/m 2 and patients who received more than (>) 200 mg/m 2 . Methods This is a cohort retrospective study conducted in the radiotherapy unit of Cipto Mangunkusumo General Hospital. Medical records of 540 patients from January 2014 to December 2018 were collected and sorted. After sorting, 120 of the records were analyzed. Results The analysis showed that 38.4% of patients who received >200 mg/m 2 cumulative dose of cisplatin experienced AKD, whereas 38.3% of the patients who received ≤200 mg/m 2 cumulative dose of cisplatin experienced AKD. Conclusion This study found that in patients with locally advanced NPC who received cisplatin chemoradiation, there was no significant difference in the incidence of AKD, recovery of renal function, or progression of chronic kidney disease between patients receiving a cumulative dose of cisplatin ≤200 mg/m 2 and those receiving >200 mg/m 2 .

Effects of CIK Cell Therapy Combined with Camrelizumab on the Quality of Life in Patients with Nasopharyngeal Carcinoma and Analysis of Prognostic Factors

“…In recent years, the immunotherapy dominated by PD-1/PD-L1 immune checkpoint inhibitors has been gradually applied to the comprehensive treatment regimen for various types of tumors. Camrelizumab is the third PD-1 drug made in China after toripalimab and sintilimab and can activate T cells by blocking PD-1/PD-L1 binding, thereby weakening the immunosuppression within the patients' organism and enhancing the tumor-killing effect [ 7 , 8 ]. Zhou et al gave the patients with advanced nasopharyngeal carcinoma targeted therapy combined with immunotherapy (anrotinib + camrelizumab), and the patients' recheck showed that they had shrunken lesions, significantly relieved cough and active shortness of breath, and remarkably improved quality of life [ 9 ], suggesting that anrotinib + camrelizumab has treatment effect on the patients with nasopharyngeal carcinoma.…”

Evaluation of a new score associated with acute kidney injury in patients treated with cisplatin based EXTREME regimen

“…We retrospectively analyzed the courses of all patients treated with cisplatin-based EXTREME regimen for various head and neck tumors at our hospital center between June 2009 and July 2022. We considered that each as independent, given that the cumulative dose did not appear to influence the risk of AKI [ 43 ], that patient management was similar between each course and that the regimen timeframe was short for each patient (negligible effect of age on kidney function).…”

Molecular Mechanisms and Biomarkers Associated with Chemotherapy-Induced AKI

“…A review of patients’ charts to ascertain the cumulative exposure to chemo- and immunotherapeutic agents and other medications is important to assess the risk of nephrotoxicity and other less common therapy-associated injuries (e.g., thrombotic microangiopathy, tubulointerstitial nephritis, glomerular diseases, and intratubular obstruction from medications) must also be considered [ 44 ]. Notably, the risk of nephrotoxicity increases from cumulative exposure to chemotherapeutic agents and other medications [ 194 , 195 ]. The risk of AKI increases with the number of nephrotoxic drugs used, and all potentially nephrotoxic agents that can be stopped should be discontinued [ 146 , 196 ].…”