Kobayashi Yasuyuki, Nishimura Kenji, Soda Tetsuji, Yamanaka Kazuaki, Hirai Toshiaki, Kishikawa Hidefumi, Ichikawa Yasuji
The Departement of Urology, Hyogo Prefectural Nishinomiya Hospital.
Hinyokika Kiyo. 2010 Jan;56(1):29-34.
A 63-year-old man on hemodialysis for chronic renal failure developed a metastatic urothelial carcinoma and was treated with combination chemotherapies. For first line therapy, gemcitabine (GEM) and carboplatin (CBDCA) were given in combination. CBDCA was administered in a target area under the curve of 5.0 mg x min/ml according to the Calvert formula, followed by infusion of GEM at 1,000 mg/m(2), with hemodialysis started 1 hour after the end of CBDCA administration. Treatment-related adverse effects were severe, with grade 4 thrombocytopenia and neutropenia. Following two cycles of that therapy, partial response (PR) was obtained for lung metastasis, while progressive disease (PD) was noted in the liver. For second line therapy, GEM and paclitaxel (PAC) were given in combination. PAC was administered at 110 mg/m(2) before GEM at 1,000 mg/m(2) with hemodialysis given on the interval days. The adverse effect was grade 3 neutropenia, which was considered acceptable. After two cycles of second line therapy, PR was obtained for both lung and liver metastases, and maintained for 6 months. We concluded that GEM/PAC combination therapy is safe and effective for urothelial carcinoma patients undergoing concurrent hemodialysis.
一名因慢性肾衰竭接受血液透析的63岁男性患转移性尿路上皮癌，并接受了联合化疗。一线治疗采用吉西他滨（GEM）和卡铂（CBDCA）联合给药。根据卡尔弗特公式，CBDCA按5.0 mg·min/ml的曲线下面积在目标区域给药，随后以1000 mg/m²输注GEM，在CBDCA给药结束1小时后开始血液透析。治疗相关不良反应严重，出现4级血小板减少和中性粒细胞减少。经过两个周期的该治疗，肺转移获得部分缓解（PR），而肝脏出现疾病进展（PD）。二线治疗采用GEM和紫杉醇（PAC）联合给药。在给予1000 mg/m²的GEM之前，先给予110 mg/m²的PAC，并在间隔日进行血液透析。不良反应为3级中性粒细胞减少，被认为是可接受的。经过两个周期的二线治疗，肺和肝转移均获得PR，并维持了6个月。我们得出结论，GEM/PAC联合治疗对同时接受血液透析的尿路上皮癌患者是安全有效的。
