Katsumata Kenji, Sumi Tetsuo, Wada Tatehiko, Mori Yasuharu, Hisada Masayuki, Kawakita Hideaki, Enomoto Masanori, Suzuki Shoji, Matsuda Daisuke, Tsuchida Akihiko, Aoki Tatsuya
Third Department of Surgery, Tokyo Medical University, 6-7-1, Nishi-Shinjuku, Shinjuku, Tokyo, Japan 160-0023.
Clin Med Oncol. 2008;2:97-101. doi: 10.4137/cmo.s412. Epub 2008 Feb 9.
Oxaliplatin, a key part of the standard regimen for colorectal cancer in Western countries, has become available in Japan. In a hemodialysis patient with cecal cancer, we investigated the efficacy, safety, pharmacokinetics, and dialysability of oxaliplatin.
A 65-year-old man who had cecal cancer was treated with oxaliplatin (40 mg/m(2)) and l-leucovorin(l-LV) (200 mg/m(2)), which were administered simultaneously over 120 min via the side and main arms of a Y-tube, respectively. Then 5-FU (400 mg/m(2)) was administered rapidly via the side tube, followed by 5-FU (2,000 mg/m(2)) over 46 hours via the main tube. The patient had chronic renal failure due to diabetic nephropathy and hemodialysis was performed 3 times a week. Blood samples were collected from the dialyzer before and after each hemodialysis session to examine platinum clearance.
The patient received 3 courses of oxaliplatin before he died of cancer. During hemodialysis, the platinum level fell from 0.32 μg/mL to 0.15 μg/mL.
Since patients with renal failure have various associated disorders and oxaliplatin has a long half-life, it is necessary to obtain more pharmacokinetic data to investigate its accumulation and dialysability during long-term treatment. Such data will assist in treating the rapidly increasing number of hemodialysis patients with colorectal cancer.
奥沙利铂是西方国家结直肠癌标准治疗方案的关键组成部分，现已在日本上市。我们对一名患有盲肠癌的血液透析患者的奥沙利铂疗效、安全性、药代动力学及透析清除率进行了研究。
一名65岁的盲肠癌男性患者接受了奥沙利铂（40mg/m²）和左亚叶酸钙（l-LV）（200mg/m²）治疗，二者分别通过Y形管的侧臂和主臂在120分钟内同时给药。然后通过侧管快速给予5-氟尿嘧啶（5-FU）（400mg/m²），随后通过主管在46小时内给予5-FU（2000mg/m²）。该患者因糖尿病肾病导致慢性肾衰竭，每周进行3次血液透析。每次血液透析前后从透析器采集血样以检测铂清除率。
该患者在死于癌症前接受了3个疗程的奥沙利铂治疗。血液透析期间，铂水平从0.32μg/mL降至0.15μg/mL。
由于肾衰竭患者存在多种相关疾病，且奥沙利铂半衰期较长，因此有必要获取更多药代动力学数据，以研究其在长期治疗中的蓄积及透析清除率。这些数据将有助于治疗数量迅速增加的结直肠癌血液透析患者。
