Comparison of myelotoxicity and nephrotoxicity between daily low-dose cisplatin with concurrent radiation and cyclic high-dose cisplatin in non-small cell lung cancer patients

Autor: Zazuli, Zulfan, Kos, Renate, Veltman, Joris D., Uyterlinde, Wilma, Longo, Cristina, Baas, Paul, Masereeuw, Rosalinde, Vijverberg, Susanne J.H., Maitland-van der Zee, Anke Hilse, Afd Pharmacology, Pharmacology, Pharmacoepidemiology and Clinical Pharmacology
Přispěvatelé: Afd Pharmacology, Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Graduate School, APH - Personalized Medicine, Pulmonology, Paediatric Pulmonology, CCA - Cancer Treatment and Quality of Life
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Frontiers in Pharmacology
Frontiers in Pharmacology, 11. FRONTIERS MEDIA SA
Frontiers in Pharmacology, 11. Frontiers Media S.A.
Frontiers in Pharmacology, Vol 11 (2020)
Frontiers in pharmacology, 11:975. Frontiers Media S.A.
ISSN: 1663-9812
DOI: 10.3389/fphar.2020.00975
Popis: Aim Antineoplastic effect of cisplatin, the first line treatment in non-small cell lung cancer (NSCLC), is hindered by its nephrotoxicity and myelotoxicity. Both low-dose and high-dose regimens are used in the management of NSCLC. The aim of this study is to assess the risk on myelotoxicity and nephrotoxicity from the daily low-dose cisplatin (DLD) treatment as compared to cyclic high-dose cisplatin (CHD). Methods A retrospective cohort study was conducted. NSCLC patients treated with cisplatin between 2011 and 2018 in the Amsterdam UMC or Antoni van Leeuwenhoek cancer hospital were studied. Myelotoxicity and nephrotoxicity were defined based on common terminology criteria (CTCAE v4.03) and categorized as >= grade 1 and >= grade 2. Modified Poisson regression and Cox proportional hazards model were used to estimate relative risks and cumulative hazard respectively. Results Of the 115 NSCLC patients receiving DLD (N=62) and CHD (N=53), 60% had >= grade 1 anemia, 33.9% leukopenia, 31.3% neutropenia, 27.8% thrombocytopenia, 32.2% acute nephrotoxicity with combined definition (Cr-electrolyte nephrotoxicity), and 58.3% chronic nephrotoxicity. The DLD group was older, had an earlier cancer stage, had more comorbidities, and had higher baseline albumin levels. In the DLD group less >= grade 2 toxicities were reported compared to the CHD group except for Cr-electrolyte nephrotoxicity. However, there was a stronger association in the DLD group with >= grade 1 leukopenia, thrombocytopenia, and Cr-electrolyte nephrotoxicity. The DLD group developed significantly more >= grade 1 leukopenia [adjusted relative risk (adjRR)=1.83, 95% CI 1.02-3.27], thrombocytopenia (adjRR=3.43, 95% CI 1.64-7.15), and >= grade 2 Cr-electrolyte nephrotoxicity (adjRR=3.02, 95% CI 1.20-7.56). The DLD group had a lower adjusted cumulative hazard for developing >= grade 2 myelotoxicity and chronic nephrotoxicity but not for Cr-electrolyte nephrotoxicity [adjusted hazard ratio (adjHR)=3.90, 95% CI 1.35-11.23]. In contrast, DLD showed protective effect to >= grade 2 nephrotoxicity when definition was restricted to the traditional creatinine-based definition (adjRR=0.07, 95% CI 0.01-0.86; adjHR=0.05, 95% CI 0.01-0.56). Conclusions Overall, the DLD regimen was safer than the CHD regimen when assessing the risk of >= grade 2 myelotoxicity and nephrotoxicity. However, this might not be the case in patients with a higher risk of electrolyte abnormalities.
Databáze: OpenAIRE
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