Continuous ambulatory peritoneal dialysis: pharmacokinetics and clinical outcome of paclitaxel and carboplatin treatment

• Published in: Cancer chemotherapy and pharmacology Vol. 62; no. 5; pp. 841 - 847
• Main Authors: Heijns, Joan B., van der Burg, Maria E. L., van Gelder, Teun, Fieren, Marien W. J. A., de Bruijn, Peter, van der Gaast, Ate, Loos, Walter J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.10.2008; Springer; Springer Nature B.V
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - pharmacokinetics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Area Under Curve; Biological and medical sciences; Cancer Research; Carboplatin - administration & dosage; Case reports; Clinical outcomes; Emergency and intensive care: renal failure. Dialysis management; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Intensive care medicine; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Oncology; Original; Original Article; Ovarian Neoplasms - drug therapy; Paclitaxel - administration & dosage; Peritoneal Dialysis, Continuous Ambulatory; Pharmacology. Drug treatments; Pharmacology/Toxicology; Renal Insufficiency - complications; Renal Insufficiency - therapy; Treatment Outcome; Tumors; Carboplatin; CAPD; Pharmacokinetic; Paclitaxel; Ovarian cancer; Antineoplastic agent; Prognosis; Ovary cancer; Malignant tumor; Peritoneal dialysis; Female genital diseases; Extrarenal dialysis; Ovarian diseases; Pharmacokinetic . Ovarian cancer; Treatment; Taxane derivatives; Ambulatory; Pharmacokinetics; Antimitotic; Cancer; Platinum II Complexes
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-007-0671-9

Purpose Administration of chemotherapy in patients with renal failure, treated with hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) is still a challenge and literature data is scarce. Here we present a case study of a patient on CAPD, treated with weekly and three-weekly paclitaxel/carboplatin for recurrent ovarian cancer. Experimental During the first, second and ninth cycle of treatment, blood, urine and CAPD samples were collected for pharmacokinetic analysis of paclitaxel and total and unbound carboplatin-derived platinum. Results Treatment was well tolerated by the patient. No excessive toxicity was observed and at the end of treatment she was in a complete remission. The plasma pharmacokinetics of paclitaxel were unaltered compared to historical data, with neglectable urinary and CAPD clearance. In contrast, the pharmacokinetics of carboplatin were altered, with doubled half-lives compared to patients with normal renal function. Of the administered carboplatin dose, up to 20% was cleared via the dialysate, while only up to 8% was cleared via the urine. Conclusion Paclitaxel and carboplatin can be safely administered to patients with chronic renal failure on CAPD. For paclitaxel the generally applied dose can be administered, and although for carboplatin dose-adjustment is required due to the diminished renal function, the dose can be calculated using Calvert’s formula.