Moderate renal dysfunction may not require a cisplatin dose reduction: a retrospective study of cancer patients with renal impairment.
OBJECTIVE
The aim of this study was to assess the tolerability of cisplatin (CDDP) in patients with moderate renal dysfunction.


METHODS
To investigate the relationship between CDDP dose and nephrotoxicity, a retrospective chart review was conducted of patients with a creatinine clearance (Ccr) of 30-60 mL/min. Subjects were classified into three groups according to the CDDP dose, as determined by the physician, and the nephrotoxicity among these groups was compared. Additionally, we investigated the correlation coefficients between maximum serum creatinine (Scr) level or minimum estimated glomerular filtration rate (eGFR) and baseline Ccr.


RESULTS
Fifty-six patients were included in this study. Among these patients, 13 patients received 30-40 mg/m(2) CDDP (group I), 18 patients received 40-70 mg/m(2) (group II), and 25 patients received 70-80 mg/m(2) (group III). No significant difference in nephrotoxicity was observed (median Scr 1.53, 1.61, and 1.53 mg/dL, respectively), and no correlation was observed between baseline Ccr and maximum Scr (r = 0.004, p = 0.979) or minimum eGFR (r = 0.21, p = 0.119). Only two patients (3.5 %) experienced grade 3 or 4 Scr elevation-one patient with a Ccr of 52.6 mL/min received 60 mg/m(2) CDDP, and the other patient with a Ccr of 52.1 mL/min received 70 mg/m(2) of CDDP. Hemodialysis was not observed.


CONCLUSIONS
CDDP was tolerated at doses of 35-80 mg/m(2) among patients with moderate renal impairment. Empiric dose reduction might create a risk of under-treatment.
Division of Pharmacy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-0882, Japan, toogawa@east.ncc.go.jp.
Tomoko
T
Ogawa
Seiji
S
Niho
Shunji
S
Nagai
Takashi
T
Kojima
Yoshiko
Y
Nishimura
Yuichiro
Y
Ohe
Naoki
N
Kondo
Takuhiro
T
Yamaguchi
Kazushi
K
Endo
Keishiro
K
Izumi
Hironobu
H
Minami
D000368:Aged; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D051437:Renal Insufficiency / Q000097:blood* / Q000139:chemically induced / Q000473:pathology; D012189:Retrospective Studies
D003404:Creatinine; D002945:Cisplatin