Successful management of chemotherapy in a stage IV ovarian cancer patient with chronic renal failure

Abstract

Because the number of hemodialysis patients is increasing, chemotherapy will need to be performed on more of these patients in the future. Carboplatin is metabolized by the kidneys and excreted in the urine, so delayed excretion caused by renal dysfunction can lead to severe adverse effects. Here, we report on the successful and safe performance of chemotherapy in a hemodialysis patient with stage IV ovarian cancer, based on alteration of the dialysis time and pharmacokinetic monitoring. A 60-year-old woman on hemodialysis for chronic renal failure was referred to our hospital with a left ovarian tumor and multiple metastases. After surgery, she received adjuvant chemotherapy with paclitaxel and carboplatin on a weekly basis. Initially, hemodialysis was done the next morning (16 h after chemotherapy), and grade 3 neutropenia occurred on day 8 of her first course. Pharmacokinetic analysis revealed the persistence of a high total blood platinum concentration until the start of hemodialysis. Therefore, hemodialysis was performed only 2 h after the second course of chemotherapy. At that time, the total platinum concentration had decreased to the range found in patients with normal renal function, and adverse effects were mild. For the third to sixth courses, chemotherapy was performed safely on an outpatient basis. Her multiple metastases were eliminated by chemotherapy. At 14 months after surgery, there is no evidence of recurrence. Keywords Carboplatin Á Hemodialysis Á Ovarian cancer This article won the excellent subject prize at the 49th Annual Meeting of the Japan Society of Clinical Oncology.

Treatment of advanced ovarian cancer with carboplatin and paclitaxel in a patient undergoing hemodialysis: Case report and literature review

“…This is a report on the feasibility of the use of paclitaxel and carboplatin in a Chinese HD patient. The doses of paclitaxel and carboplatin were similar to those used in a previous report from Japan 8 . Paclitaxel is metabolized mainly in the liver and secreted into bile.…”

“…It seems that there is no clear correlation between the dose of free platinum and bone marrow suppression. In addition, Kaku et al 8 reported that by changing the interval between the infusion and HD, the AUC can be reduced, thereby reducing blood toxicity after carboplatin chemotherapy. Takeda also confirmed this view 19 .…”

“…The doses of paclitaxel and carboplatin were similar to those used in a previous report from Japan. 8 Paclitaxel is metabolized mainly in the liver and secreted into bile. Only 5%-10% is extracted by the kidney.…”

“…As shown in the 17 cases in Table 1, 15 cases were infused with chemotherapy regimens including platinum drugs. Including 12 cases of Asians, 3,[6][7][8][9][10][11][12]16,17 almost all had different degrees of bone marrow suppression. Six of these cases suffered grade 4 bone marrow suppression.…”

“…There have been few cases of the PC chemotherapy in HD patients with ovarian cancer. [3][4][5][6][7][8][9][10][11][12] The dose and time interval between the administration of carboplatin and HD are difficult to determine. This study presents the course of treatment for a HD patient with ovarian cancer.…”