Li Y F, Fu S, Hu W, Liu J H, Finkel K W, Gershenson D M, Kavanagh J J
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230, USA.
Int J Gynecol Cancer. 2007 Jul-Aug;17(4):739-63. doi: 10.1111/j.1525-1438.2007.00847.x. Epub 2007 Feb 16.
Chronic kidney disease is a common occurrence in patients with gynecological cancer. Systemic anticancer treatment in such patients is a challenge for clinicians because of altered drug pharmacokinetics. For those drugs that are excreted mainly by the kidneys, decreased renal function may lead to increased systemic exposure and increased toxicity. Dose adjustment based on pharmacokinetic changes is required in this situation to avoid life-threatening toxicity. In this review, we summarize the nephrotoxicity and pharmacokinetic data of agents commonly used in systemic anticancer treatment of gynecological cancers and dose adjustment guidelines in the presence of impaired renal function. We review 17 medications that need dose adjustment (cisplatin, carboplatin, doxorubicin, epirubicin, cyclophosphamide, ifosfamide, topotecan, irinotecan, etoposide, capecitabine, bleomycin, methotrexate, actinomycin D, granulocyte-macrophage colony-stimulating factor, metoclopramide, cimetidine, and diphenhydramine) as well as 27 drugs that do not (paclitaxel, docetaxel, pegylated liposomal doxorubicin, gemcitabine, oxaliplatin, fluorouracil, vincristine, letrozole, anastrozole, tamoxifen, leuprorelin, megestrol, gefitinib, erlotinib, trastuzumab, leucovorin, granulocyte colony-stimulating factor, erythropoietin, ondansetron, granisetron, palonosetron, tropisetron, dolasetron, aprepitant, dexamethasone, lorazepam, and diazepam). We also review the formulae commonly used to estimate creatinine clearance, including Cockcroft-Gault, Chatelut, Jelliffe, Wright, and the Modification of Diet in Renal Disease study formulae.
慢性肾脏病在妇科癌症患者中很常见。由于药物药代动力学改变，对此类患者进行全身抗癌治疗对临床医生来说是一项挑战。对于那些主要经肾脏排泄的药物，肾功能下降可能导致全身暴露增加和毒性增加。在这种情况下，需要根据药代动力学变化调整剂量，以避免危及生命的毒性。在本综述中，我们总结了妇科癌症全身抗癌治疗中常用药物的肾毒性和药代动力学数据，以及肾功能受损时的剂量调整指南。我们回顾了17种需要调整剂量的药物（顺铂、卡铂、多柔比星、表柔比星、环磷酰胺、异环磷酰胺、拓扑替康、伊立替康、依托泊苷、卡培他滨、博来霉素、甲氨蝶呤、放线菌素D、粒细胞-巨噬细胞集落刺激因子、甲氧氯普胺、西咪替丁和苯海拉明）以及27种不需要调整剂量的药物（紫杉醇、多西他赛、聚乙二醇化脂质体多柔比星、吉西他滨、奥沙利铂、氟尿嘧啶、长春新碱、来曲唑、阿那曲唑、他莫昔芬、亮丙瑞林、甲地孕酮、吉非替尼、厄洛替尼、曲妥珠单抗、亚叶酸钙、粒细胞集落刺激因子、促红细胞生成素、昂丹司琼、格拉司琼、帕洛诺司琼、托烷司琼、多拉司琼、阿瑞匹坦、地塞米松、劳拉西泮和地西泮）。我们还回顾了常用于估算肌酐清除率的公式，包括Cockcroft-Gault公式、Chatelut公式、Jelliffe公式、Wright公式以及肾脏病饮食改良研究公式。
