Feasibility of combination chemotherapy with cisplatin and etoposide for haemodialysis patients with lung cancer

Abstract

Cancer chemotherapy for haemodialysis patients has never been established. To elucidate the feasibility of cisplatin-based combination chemotherapy for haemodialysis patients with lung cancer, a dose escalation study was conducted. Five haemodialysis patients with lung cancer were treated with cisplatin and etoposide. A starting dose of 40 mg m À2 of cisplatin on day 1 and 50 mg m À2 of etoposide on days 1, 3 and 5 were administered as the first course for the first patient. Membrane haemodialysis was regularly performed three times a week and soon after the completion of therapy. By monitoring toxicity and pharmacokinetics data, the dose was escalated course by course and patient by patient. Dose escalation was completed for the first two patients resulting in full-dose chemotherapy consisting of 80 mg m À2 of cisplatin on day 1 and 100 mg m À2 of etoposide on days 1, 3 and 5. Multiple courses of the full-dose chemotherapy were administered to the other three patients. Toxicity was manageable and tolerable for all. Pharmacokinetics data were comparable to those from patients with normal renal function, except for potential long-lasting higher levels of free platinum in the renal insufficiency group. In conclusion, this standard-dose combination chemotherapy was feasible even for haemodialysis patients.

In vitro sensitivity testing of minimally passaged and uncultured gliomas with TRAIL and/or chemotherapy drugs

“…Cisplatin was the most effective of the drugs tested in vitro, however strong toxicity was triggered only by the higher of the doses employed, which corresponded to the peak intratumoral cisplatin level following embolisation (Tegeder et al, 2003). Only partial sensitivity was observed using a 10-fold lower concentration, which resembles peak tumour and plasma levels achieved following systemic cisplatin administration (Riva et al, 2000;Tegeder et al, 2003;Watanabe et al, 2003;Siegel-Lakhai et al, 2005). A few gliomas were more sensitive than normal cells to cotreatments with TRAIL and chemotherapy drugs.…”

Successful Chemotherapy for Small-Cell Lung Cancer in an Elderly Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

“…There are also several reports of chemotherapy in SCLC or NSCLC patients on HD (9)(10)(11). However, the present report is the first to describe successful chemotherapy in an SCLC patient on CAPD, partly because among the current renal replacement therapies in Japan and the United States, limited numbers of patients have elected to receive CAPD (7,12).…”

“…Carboplatin or CBDCA-derived platinum is mainly cleared (70%) by renal excretion (16). CAPD eliminates none or only 14-20% of the administered CBDCA during the first 24 hours (8,9,26 (11,26). In our patient, ETP concentrations were decreased as expected on the next day, although the exact clearance pathway was also undetermined.…”

Successful Treatment of Mediastinal Seminoma in a Hemodialysis Patient

“…Approximately 40% of an etoposide dose is excreted by thekidneys [21].Hypoalbuminemiadoesnotaffectetoposide kinetics but increases unbound etoposide, resulting in an increaseinfreeetoposideAUC [22].Table1Bsummarizesthe experienceintreatingpatientswithetoposideandhemodialysis [14,15,18,23].Thepharmacokineticcurvesforetoposide fit a two-compartment model, and the pharmacokinetic parametersarecomparablewiththoseobtainedinpatientswith normalrenalfunction [24].Hemodialysisdoesnotdisturbthe exponentialdecayofplasmaetoposideconcentrationduring theeliminationphase,andnoetoposideisfoundinthedialysate.Therefore,ithasbeenrecommendedthattheetoposide dose in hemodialysis patients be reduced by 50%. Because etoposide is not removed by hemodialysis, it can be given beforeorafterhemodialysissession.…”