Hepatic Arterial Infusion of Oxaliplatin for a Patient with Hepatic Metastases from Colon Cancer Undergoing Hemodialysis

Abstract

There has been no previous report of oxaliplatin administration in patients undergoing hemodialysis. A 65-year-old female with end-stage renal disease who was undergoing hemodialysis presented with anemia in August 2005. She was diagnosed with colon cancer with multiple liver metastases. After colectomy, hepatic arterial infusion chemotherapy of 5-fluorouracil was initiated and systemic administration of irinotecan was later added. After 3 months of treatment, liver metastases were strikingly reduced in size, and the carcinoembryonic antigen level decreased from 336 to 14.2 ng/ml. Eight months after treatment initiation, liver metastases increased in size with higher levels of carcinoembryonic antigen, therefore hepatic arterial infusion of oxaliplatin 60 mg was initiated. Hepatic arterial infusion was performed biweekly during hemodialysis and blood platinum concentrations were assessed. At the first cycle, the area under the curve of total platinum was 19.39 microg h/ml and that of free platinum was 5.51 microg h/ml. After six treatment cycles, the carcinoembryonic antigen level declined from 335 to 123 ng/ml. After eight treatment cycles, she experienced transient fever and impaired consciousness as a result of cholangitis, which improved following administration of antibiotics. We propose that limited cycles of hepatic arterial infusion of oxaliplatin are feasible in patients undergoing hemodialysis and this may become a strategy for treating hepatic metastases from colon cancer in patients undergoing hemodialysis.

Safety of Regular-Dose Imatinib Therapy in Patients with Gastrointestinal Stromal Tumors Undergoing Dialysis

“…Dialysis patients with esophageal cancer have been administered 5-fluorouracil and cisplatin [ 7 , 8 , 9 ] and dialysis patients with gastric cancer have been administered tegafur-uracil, docetaxel, and irinotecan [ 10 , 13 ]. Dialysis patients with colon cancer have been treated with tegafur-uracil, irinotecan, and oxaliplatin [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. In these cases, most cytotoxic drugs were used safely without dose modification, but irinotecan caused severe myelosuppression and resulted in death [ 15 , 18 ].…”

Dosing oxaliplatin in a haemodialysis patient with metastatic rectum cancer monitored by free platinum concentrations

“…4 Only a few case reports of dosing oxaliplatin in haemodialysis patients have been published to date. [5][6][7][8][9] In this study, we investigated whether dosing of oxaliplatin in a haemodialysis patient with metastatic rectum cancer monitored by measuring free platinum plasma concentrations was effective, safe and feasible in clinical practice. ing laboratory.…”

“…This is also described in other case reports. [5][6][7][8][9] The second peak is not seen in patients with normal renal function and may be caused by the dissociation of the platinum bound to plasma proteins and blood cells or by redistribution of platinum from tissue. In patients with normal renal function, it is likely that free platinum is rapidly eliminated by renal excretion, so no second peak is observed.…”

“…There is a strong correlation between glomerular filtration rate (GFR) and drug clearance measured as free platinum concentrations and also between GFR and free platinum area under the curve (AUC). [5][6][7][8][9] In this study, we investigated whether dosing of oxaliplatin in a haemodialysis patient with metastatic rectum cancer monitored by measuring free platinum plasma concentrations was effective, safe and feasible in clinical practice. 4 Only a few case reports of dosing oxaliplatin in haemodialysis patients have been published to date.…”

Gestion des chimiothérapies chez les patients hémodialysés

“…Ainsi, l'ensemble de ces cas regroupant différents dosages et schémas d'administration, il est difficile d'émettre de recommandations précises quant à son utilisation chez les patients dialysés. Dans la mesure où l'oxaliplatine est dialysable [53,56], il est préférable d'administrer l'oxaliplatine après la séance, les jours d'hémodialyse ou un jour sans dialyse [53]. Par conséquent, l'oxaliplatine n'est pas recommandé chez les patients dialysés.…”