T O'Dwyer Richard, Jiang Di Maria, Kitchlu Abhijat, Coulombe Antoine Morin, Sridhar Srikala S
Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Future Oncol. 2024;20(36):2889-2899. doi: 10.1080/14796694.2024.2342227. Epub 2024 May 5.
Despite recent advances in the management of urothelial cancer (UC), cisplatin-based combination chemotherapy regimens remain critical. However, their use can be complicated in patients with chronic kidney disease (CKD), which is not uncommon in UC patients. Based on the Galsky criteria for cisplatin ineligibility, most patients with CKD will be excluded from receiving cisplatin-based chemotherapy altogether. For patients with borderline kidney function, several strategies - such as the use of split-dose cisplatin, dose reductions, or extra hydration - may facilitate the use of cisplatin, but these need to be prospectively validated. This review highlights the critical need for a multidisciplinary team, including onco-nephrologists, to help manage renal complications and optimize delivery of cancer care in complex UC patients with CKD.
尽管尿路上皮癌（UC）的治疗最近取得了进展，但基于顺铂的联合化疗方案仍然至关重要。然而，对于慢性肾脏病（CKD）患者，这些方案的使用可能会变得复杂，而CKD在UC患者中并不少见。根据顺铂不适用的Galsky标准，大多数CKD患者将完全被排除在接受基于顺铂的化疗之外。对于肾功能临界的患者，几种策略——如使用分剂量顺铂、降低剂量或额外补液——可能有助于顺铂的使用，但这些需要前瞻性验证。本综述强调了包括肿瘤肾病学家在内的多学科团队的迫切需求，以帮助管理复杂的CKD合并UC患者的肾脏并发症并优化癌症护理的提供。
