Less nephrotoxicity of paclitaxel and ifosfamide plus nedaplatin for refractory or relapsed germ cell tumors in patients with impaired renal function

Abstract

Objectives To determine the safety and efficacy of the combined regimen of paclitaxel and ifosfamide plus nedaplatin for patients with refractory or relapsed germ cell tumors and impaired renal function. Methods Of a total of 68 patients who received paclitaxel, ifosfamide and nedaplatin chemotherapy for germ cell tumors, those with an estimated glomerular filtration rate <60 mL/min/1.73 m2 before paclitaxel, ifosfamide and nedaplatin treatment were defined as having renal dysfunction. The combination chemotherapy regimen included paclitaxel (210 mg/m2 on day 1) and ifosfamide (1.2 g/m2 on days 2–6) with nedaplatin (100 mg/m2 on day 2) on a 3‐week cycle. Results A total of 10 patients had renal dysfunction with a median estimated glomerular filtration rate of 49.97 mg/mL/1.73 m2 (range 31.7–57.5 mg/mL/1.73 m2). Paclitaxel, ifosfamide and nedaplatin chemotherapy was given as second‐line therapy in four patients, third‐line in four and fourth‐line or later in two. Patients with impaired renal function received pretreatment of a median of 5.5 cycles of platinum‐based chemotherapy (range 3–11 cycles) with a median cisplatin dose of 550 mg/m2. The patients were given two to six cycles of paclitaxel, ifosfamide and nedaplatin chemotherapy with no dose reduction, with an overall response rate of 60%. Chemotherapy‐induced kidney dysfunction was not observed in any patient with decreased renal function. Furthermore, there was no difference in the frequency of adverse events between patients with renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2) and those with normal renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2). Conclusions Paclitaxel, ifosfamide and nedaplatin chemotherapy can be considered a safe and effective regimen that results in less nephrotoxicity in germ cell tumor patients with renal dysfunction.

Efek Samping Kemoterapi Berbasis Karboplatin Terhadap Fungsi Ginjal Pada Pasien Kanker Ginekologi

“…26 Namun, banyak dilaporkan efek samping pada pemberian golongan taxan yaitu lemas (fatigue) (27-74%), myalgia (23-33%), nyeri sendi/arthralgia (20-30%), mual (20-45%), neuropati sensoris perifer simetris (20-64%), dan neutropenia (45-95%). [27][28][29] Selain itu, diketahui bahwa paclitaxel, ifosfamide dan nedaplatin merupakan kemoterapi yang aman dan efektif yang menghasilkan lebih sedikit nefrotoksisitas pada pasien tumor sel germinal dengan disfungsi ginjal. 30 Oleh karna itu, apabila terdapat penurunan fungsi ginjal pada penelitian ini, maka kemungkinan besar disebabkan oleh karboplatin, bukan karena efek dari paclitaxel atau docetaxel.…”