Motzer R J, Niedzwiecki D, Isaacs M, Menendez-Botet C, Tong W P, Flombaum C, Scher H I, Bosl G J
Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Cancer Chemother Pharmacol. 1990;27(3):234-8. doi: 10.1007/BF00685719.
Three patients with renal insufficiency requiring hemodialysis were treated with carboplatin at 100 mg/m2 in combination with etoposide for advanced germ-cell tumor (GCT, two cases) or Adriamycin + vinblastine for a transitional-cell carcinoma of the ureter (one case). Hemodialysis was performed 24 h after the administration of carboplatin. Both patients with GCT achieved a complete response, and the patient with transitional-cell carcinoma of the ureter was inevaluable for response but his disease has not progressed. The dose of carboplatin was increased in one patient as renal function improved on therapy. In two patients, the pharmacokinetics of carboplatin were determined; the pre-dialysis half-lives, AUC, and total body clearances of free carboplatin-derived platinum were estimated to be 32 and 18.3 h, 4.93 and 6.17 mg ml-1 min, and 18.2 and 18.7 ml/min, respectively. The dialysis elimination half-lives (t1/2 beta) of 2 and 3 h, respectively, for these two patients were markedly lower than the predialysis values, indicating that carboplatin was dialyzed. In summary, carboplatin can be given to patients with severe renal insufficiency. Adequate AUCs were achieved and dialysis limited systemic exposure to free carboplatin.
三名需要血液透析的肾功能不全患者接受了卡铂治疗，剂量为100mg/m²，联合依托泊苷治疗晚期生殖细胞肿瘤（GCT，2例），或联合阿霉素+长春花碱治疗输尿管移行细胞癌（1例）。在给予卡铂24小时后进行血液透析。两名GCT患者均达到完全缓解，输尿管移行细胞癌患者的反应无法评估，但疾病未进展。一名患者在治疗过程中肾功能改善后增加了卡铂剂量。对两名患者测定了卡铂的药代动力学；透析前游离卡铂衍生铂的半衰期、AUC和全身清除率估计分别为32小时和18.3小时、4.93mg/ml·min和6.17mg/ml·min、18.2ml/min和18.7ml/min。这两名患者的透析清除半衰期（t1/2β）分别为2小时和3小时，明显低于透析前值，表明卡铂可被透析清除。总之，严重肾功能不全患者可以使用卡铂。可达到足够的AUC，透析限制了游离卡铂的全身暴露。
