Impact of Sodium Thiosulfate on Prevention of Nephrotoxicities in HIPEC: An Ancillary Evaluation of Cisplatin-Induced Toxicities in Ovarian Cancer.

Autor: Senguttuvan RN; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Santiago NL; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Han ES; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Lee B; Department of Surgery, Stanford, Stanford, CA, USA., Lee S; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Lin WC; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Kebria M; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Hakim A; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Lin JF; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Wakabayashi MT; Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA., Ruel N; Biostatistics Core, City of Hope BRI, Duarte, CA, USA., Tinsley R; Clinical Trials Office, COH, Duarte, CA, USA., Eng M; Clinical Trials Office, COH, Duarte, CA, USA., Stewart DB; Department of Medical Oncology, COH, Duarte, CA, USA., Wang EW; Department of Medical Oncology, COH, Duarte, CA, USA., Paz BI; Division of Surgical Oncology, Department of Surgery, COH, Duarte, CA, USA., Wu X; Integrative Genomics Core, City of Hope Beckman Research Institute (BRI), Duarte, CA, USA., Cho H; Integrative Genomics Core, City of Hope Beckman Research Institute (BRI), Duarte, CA, USA., Liang WS; Translational Genomics Research Institute, Phoenix, AZ, USA., Rodriguez-Rodriguez L; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA., Cristea MC; Department of Surgery, Stanford, Stanford, CA, USA., Raoof M; Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA., Dellinger TH; Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center (COH), Duarte, CA, USA. tdellinger@coh.org.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2023 Dec; Vol. 30 (13), pp. 8144-8155. Date of Electronic Publication: 2023 Sep 14.
DOI: 10.1245/s10434-023-14216-6
Abstrakt: Purpose: Hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin confers a survival benefit in epithelial ovarian cancer (EOC) but is associated with renal toxicity. Sodium thiosulfate (ST) is used for nephroprotection for HIPEC with cisplatin, but standard HIPEC practices vary.
Methods: A prospective, nonrandomized, clinical trial evaluated safety outcomes of HIPEC with cisplatin 75 mg/m 2 during cytoreductive surgery (CRS) in patients with EOC (n = 34) and endometrial cancer (n = 6). Twenty-one patients received no ST (nST), and 19 received ST. Adverse events (AEs) were reported according to CTCAE v.5.0. Serum creatinine (Cr) was collected preoperatively and postoperatively (Days 5-8). Progression-free survival (PFS) was followed. Normal peritoneum was biopsied before and after HIPEC for whole transcriptomic sequencing to identify RNAseq signatures correlating with AEs.
Results: Forty patients had HIPEC at the time of interval or secondary CRS. Renal toxicities in the nST group were 33% any grade AE and 9% grade 3 AEs. The ST group demonstrated no renal AEs. Median postoperative Cr in the nST group was 1.1 mg/dL and 0.5 mg/dL in the ST group (p = 0.0001). Median change in Cr from preoperative to postoperative levels were + 53% (nST) compared with - 9.6% (ST) (p = 0.003). PFS did not differ between the ST and nST groups in primary or recurrent EOC patients. Renal AEs were associated with downregulation of metabolic pathways and upregulation of immune pathways.
Conclusions: ST significantly reduces acute renal toxicity associated with HIPEC with cisplatin in ovarian cancer patients. As nephrotoxicity is high in HIPEC with cisplatin, nephroprotective agents should be considered.
(© 2023. The Author(s).)
Databáze: MEDLINE
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