Chemotherapy for primary mediastinal yolk sac tumor in a patient undergoing chronic hemodialysis: a case report
Autor: | Haruki Hirakawa, Shinya Kimura, Kazuo Matsubara, Naoko Sueoka-Aragane, Tomomi Nakamura, Chiho Nakashima, Taro Funakoshi, Takahiro Horimatsu, Shunsaku Nakagawa, Manabu Muto, Masanori Masuda |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty medicine.medical_treatment Urology Case Report Antineoplastic Agents Mediastinal yolk sac tumor Mediastinal Neoplasms 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Renal Dialysis Antineoplastic Combined Chemotherapy Protocols medicine Humans Renal insufficiency Etoposide Medicine(all) Chemotherapy business.industry Endodermal Sinus Tumor Mediastinum Area under the curve General Medicine Surgery Regimen 030104 developmental biology Hemodialysis 030220 oncology & carcinogenesis Pharmacodynamics Concomitant Cisplatin Tomography X-Ray Computed business medicine.drug |
Zdroj: | Journal of Medical Case Reports |
ISSN: | 1752-1947 |
Popis: | Background: The safety and efficacy of chemotherapy for patients undergoing concomitant hemodialysis have not been fully established and optimal doses of anti-cancer drugs and best timing of hemodialysis remains unclear. Although chemosensitive cancers, such as germ cell tumors, treated with chemotherapy should have sufficient dose intensity maintained to achieve the desired effect, many patients with cancer undergoing hemodialysis might be under-treated because the pharmacokinetics of anti-cancer drugs in such patients remains unknown. Case presentation: We describe a 31-year-old Japanese man with a mediastinal yolk sac tumor treated with surgery followed by five cycles of chemotherapy containing cisplatin and etoposide while concomitantly undergoing hemodialysis. The doses of these agents used in the first cycle were 50% of the standard dose of cisplatin (10 mg/m2) and 60% of the standard dose of etoposide (60 mg/m2) on days 1 through to 5; the doses were subsequently escalated to 75% with both agents. Hemodialysis was started 1 hour after infusions of these agents. Severe hematological toxicities were observed despite successful treatment. During treatment with concurrent hemodialysis, pharmacokinetic analysis of cisplatin was performed and its relationship with adverse effects was assessed. Compared with patients with normal renal function, the maximum drug concentration was higher, and concentration increased in the interval between hemodialysis and the subsequent cisplatin infusion, resulting in a higher area under the curve despite a reduction in the dose to 75% of the standard regimen. Conclusions: Because of the altered pharmacokinetics pharmacodynamics status of patients with renal dysfunction undergoing hemodialysis, pharmacokinetics pharmacodynamics analysis is deemed to be helpful for effective and safe management of chemotherapy in patients undergoing hemodialysis. |
Databáze: | OpenAIRE |
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