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

Abstract

The number of cancer patients undergoing dialysis has been increasing, and the number of these patients on chemotherapy is also increasing. Imatinib is an effective and safe therapy for KIT-positive gastrointestinal stromal tumors (GIST), but the efficacy and safety of imatinib in dialysis patients remain unclear. Because clinical trials have not been conducted in this population, more investigations are required. We report on a 75-year-old Japanese man undergoing dialysis who presented with massive tarry stool from a duodenal GIST. The duodenal GIST was 14 cm in diameter with multiple liver and bone metastases. The patient underwent an urgent pancreaticoduodenectomy to achieve hemostasis. After surgery, he was administered imatinib 400 mg/day. No severe adverse event including myelosuppression, congestive heart failure, liver functional impairment, intestinal pneumonia, or Steven-Johnson syndrome occurred, and the liver metastasis remained stable for 4 months. During chemotherapy, hemodialysis continued three times per week without adverse events. We suggest that regular-dose imatinib is an effective and safe treatment in patients with GIST undergoing dialysis. In addition, we present a literature review of the effectiveness and safety of imatinib treatment in dialysis patients.

The Impact of Hemodialysis and Liver Cirrhosis on the Plasma Concentrations of Tyrosine Kinase Inhibitors in a Patient with Chronic Myeloid Leukemia

“…At present, there are few reports about TKI treatment in HD patients. In previous cases, imatinib was given to 7 HD patients (16)(17)(18)(19)(20): in only one case, the plasma concentration of imatinib was measured, and there was no difference between before and after HD (16). Moreover, apparent toxicities of the imatinib for the HD patients have been rarely reported so far (Table 2), which suggests that it is not necessary to modify the dose of imatinib given to CML patients on HD.…”

Hemodialysis and imatinib: Plasma levels, efficacy and tolerability in a patient with metastatic GIST - Case report

“…In another case report, the drug was used as an adjuvant, again without toxicity [ 24 ]. In the last case available, the patient progressed after 4 months but it is unknown if the underlying mutation was sensitive to imatinib [ 25 ]. Among chronic myeloid leukemia patients, in one study a progressive increase of plasma levels of imatinib was reported, causing severe adverse effects requiring dose reduction [ 26 ].…”

Eribulin as a Feasible and Safe Monotherapy in a Dialytic Pretreated Woman with Metastatic Breast Cancer: A Case Report

“…Chemotherapy in dialysis patients is challenging because drug excretion differs from that of non-dialysis patients. Drugs that are excreted by dialysis may show reduced efficacy, while those that are not excreted may cause adverse events [10].…”