Shitara Kohei, Munakata Masaki, Muto Osamu, Okada Ristuko, Mitobe Sumako, Mino Masanari, Ikami Isao, Sakata Yuh
Department of Medical Oncology, Misawa City Hospital, Misawa, Aomori, Japan.
Jpn J Clin Oncol. 2007 Jul;37(7):540-3. doi: 10.1093/jjco/hym044. Epub 2007 Aug 4.
There has been no previous report of oxaliplatin administration in patients undergoing hemodialysis. A 65-year-old female with end-stage renal disease who was undergoing hemodialysis presented with anemia in August 2005. She was diagnosed with colon cancer with multiple liver metastases. After colectomy, hepatic arterial infusion chemotherapy of 5-fluorouracil was initiated and systemic administration of irinotecan was later added. After 3 months of treatment, liver metastases were strikingly reduced in size, and the carcinoembryonic antigen level decreased from 336 to 14.2 ng/ml. Eight months after treatment initiation, liver metastases increased in size with higher levels of carcinoembryonic antigen, therefore hepatic arterial infusion of oxaliplatin 60 mg was initiated. Hepatic arterial infusion was performed biweekly during hemodialysis and blood platinum concentrations were assessed. At the first cycle, the area under the curve of total platinum was 19.39 microg h/ml and that of free platinum was 5.51 microg h/ml. After six treatment cycles, the carcinoembryonic antigen level declined from 335 to 123 ng/ml. After eight treatment cycles, she experienced transient fever and impaired consciousness as a result of cholangitis, which improved following administration of antibiotics. We propose that limited cycles of hepatic arterial infusion of oxaliplatin are feasible in patients undergoing hemodialysis and this may become a strategy for treating hepatic metastases from colon cancer in patients undergoing hemodialysis.
此前尚无关于接受血液透析的患者使用奥沙利铂的报道。一名65岁的终末期肾病女性患者，正在接受血液透析，于2005年8月出现贫血。她被诊断为结肠癌伴多发肝转移。结肠切除术后，开始进行5-氟尿嘧啶肝动脉灌注化疗，随后加用伊立替康全身给药。治疗3个月后，肝转移灶大小显著缩小，癌胚抗原水平从336降至14.2 ng/ml。治疗开始8个月后，肝转移灶增大，癌胚抗原水平升高，因此开始进行60 mg奥沙利铂肝动脉灌注。在血液透析期间每两周进行一次肝动脉灌注，并评估血铂浓度。在第一个周期，总铂曲线下面积为19.39 μg h/ml，游离铂曲线下面积为5.51 μg h/ml。经过六个治疗周期后，癌胚抗原水平从335降至123 ng/ml。经过八个治疗周期后，她因胆管炎出现短暂发热和意识障碍，使用抗生素后病情好转。我们认为，有限周期的奥沙利铂肝动脉灌注对接受血液透析的患者是可行的，这可能成为治疗接受血液透析的结肠癌肝转移患者的一种策略。
