With refinements and advances in
hemodialysis techniques, survival for patients with
end-stage renal disease has improved significantly. To our knowledge, however, no prospective trials have been performed in patients receiving
hemodialysis who are also diagnosed with
cancer and are candidates for
chemotherapy. We describe a 73-year-old man who was diagnosed with high-grade
neuroendocrine carcinoma, metastatic to the bone and lymph nodes, and was undergoing
hemodialysis. Although
cisplatin is more commonly used in the treatment of metastatic neuroendocrine
cancers, it may not be the best option in patients who suffer from
renal insufficiency.
Carboplatin is a second-generation, nonnephrotoxic
platinum analog that can be hemodialyzed, although no formal guidelines are available regarding the dosing for patients receiving
hemodialysis. This case describes a patient who was treated with five cycles of combination
carboplatin 115 mg/m(2) on day 1 and
etoposide 50 mg/m(2) on day 1 and day 3 of a 28-day cycle. Dialysis was performed for 3.5 hours starting 90 minutes after completion of
carboplatin on day 1. Pharmacokinetic assessments were performed at 1, 2, 4, and 12 hours after
chemotherapy infusion on day 1 of cycle 1. Total
carboplatin concentrations in plasma and
platinum ultrafiltrate were measured. The plasma concentration of free
platinum at the end of the infusion was 31,000 ng/ml, and the area under the plasma concentration-time curve was 2.9 minute·mg/ml. No significant
carboplatin-related toxicities were reported. This case report indicates that
carboplatin can be safely administered in patients receiving
hemodialysis.