Watanabe R, Takiguchi Y, Moriya T, Oda S, Kurosu K, Tanabe N, Tatsumi K, Nagao K, Kuriyama T
Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Br J Cancer. 2003 Jan 13;88(1):25-30. doi: 10.1038/sj.bjc.6600687.
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(-2) of cisplatin on day 1 and 50 mg m(-2) 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(-2) of cisplatin on day 1 and 100 mg m(-2) 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.
血液透析患者的癌症化疗方案尚未确立。为阐明基于顺铂的联合化疗用于肺癌血液透析患者的可行性，开展了一项剂量递增研究。五名肺癌血液透析患者接受了顺铂和依托泊苷治疗。第一名患者的第一个疗程为第1天给予40mg/m²顺铂，第1、3和5天给予50mg/m²依托泊苷。每周定期进行三次膜式血液透析，且在治疗结束后不久进行。通过监测毒性和药代动力学数据，逐疗程、逐患者地增加剂量。前两名患者完成了剂量递增，最终全剂量化疗方案为第1天给予80mg/m²顺铂，第1、3和5天给予100mg/m²依托泊苷。另外三名患者接受了多个疗程的全剂量化疗。所有患者的毒性均可控且可耐受。药代动力学数据与肾功能正常的患者相当，但肾功能不全组的游离铂水平可能会持续较高。总之，这种标准剂量的联合化疗即使对于血液透析患者也是可行的。
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