title: Chemotherapy for primary mediastinal yolk sac tumor in a patient undergoing chronic hemodialysis: a case report.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Naoko Sueoka-Aragane, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Hirakawa
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Naoko Sueoka-Aragane, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Nakashima
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Naoko Sueoka-Aragane, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Pathology, Faculty of Medicine, Saga University Hospital, Saga, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Funakoshi
authors.affiliation: Department of Pharmacy, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Horimatsu
authors.affiliation: Department of Pharmacy, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Matsubara
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Muto
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Naoko Sueoka-Aragane, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Naoko Sueoka-Aragane, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan. sueokan@cc.saga-u.ac.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sueoka-Aragane
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000493:pharmacokinetics; D018240:Endodermal Sinus Tumor / Q000188:drug therapy* / Q000378:metabolism; D005047:Etoposide / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D008482:Mediastinum / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D002945:Cisplatin
keywords: Cisplatin; Hemodialysis; Mediastinal yolk sac tumor; Pharmacokinetics; Renal insufficiency