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Combination chemotherapy with gemcitabine and nab-paclitaxel for a metastatic pancreatic ductal adenocarcinoma patient undergoing hemodialysis

  • Takashi KanekoEmail author
  • Kazuya Sugimori
  • Yuichiro Tozuka
  • Taito Fukushima
  • Kazuya Okada
  • Hiroyuki Oka
  • Hiroshi Okazaki
  • Shin Maeda
Case Report
  • 6 Downloads

Abstract

In cancer patients, impairment of kidney function is not uncommon. Recently, the efficacy of the combination of gemcitabine and nab-paclitaxel for pancreatic ductal adenocarcinoma (PDAC) patients has been reported, however, there is no recommendation for dose and administration to patients undergoing hemodialysis (HD). A 66-year-old man began receiving HD for chronic renal failure 4 years previously. He suffered from diarrhea, back pain, and loss of appetite, and his weight gradually decreased. Abdominal dynamic computed tomography showed a 45-mm hypodense mass in the pancreatic body and a 30-mm hypodense mass in the liver. The patient was diagnosed with metastatic PDAC. He started combination chemotherapy of gemcitabine and nab-paclitaxel without dose modification. He developed pneumonia and neutropenia in the first and second courses, so we modified to a 60% dose of gemcitabine and nab-paclitaxel on day 1 every 2 weeks. After dose modification, he continued combination chemotherapy for over 7 months without severe adverse events or tumor progression. Combination chemotherapy using gemcitabine and nab-paclitaxel was effective in a PDAC patient undergoing HD. While it is possible to originally administer these drugs with no dose modification, early dose modification was needed for our patient because of severe adverse events.

Keywords

Pancreatic cancer Hemodialysis Gemcitabine Nab-paclitaxel Combination chemotherapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Sohal DP, Mangu PB, Khorana AA, et al. Metastatic pancreatic cancer: American Society Of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34:2784–96.CrossRefGoogle Scholar
  2. 2.
    Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.CrossRefGoogle Scholar
  3. 3.
    Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.CrossRefGoogle Scholar
  4. 4.
    Ueno H, Ikeda M, Ueno M, et al. Phase I/II study of nab-paclitaxel plus gemcitabine for chemotherapy-naïve Japanese patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2016;77:595–603.CrossRefGoogle Scholar
  5. 5.
    Takakura K, Koido S, Takahara A, et al. Long-term management of gemcitabine in a patient with advanced pancreatic cancer undergoing haemodialysis. J Chemother. 2014;26:369–72.CrossRefGoogle Scholar
  6. 6.
    Kiani A, Köhne CH, Franz T, et al. Pharmacokinetics of gemcitabine in a patient with end-stage renal disease: effective clearance of its main metabolite by standard hemodialysis treatment. Cancer Chemother Pharmacol. 2003;51:266–70.Google Scholar
  7. 7.
    Wong G, Hayen A, Chapman JR, et al. Association of CKD and cancer risk in older people. J Am Soc Nephrol. 2009;20:1341–50.CrossRefGoogle Scholar
  8. 8.
    Chien CC, Han MM, Chiu YH, et al. Epidemiology of cancer in end-stage renal disease dialysis patients: a national cohort study in Taiwan. J Cancer. 2017;8:9–18.CrossRefGoogle Scholar
  9. 9.
    Lin MY, Kuo MC, Hung CC, et al. Association of dialysis with the risks of cancers. PLoS One. 2015;10:e0122856.CrossRefGoogle Scholar
  10. 10.
    Stengel B. Chronic kidney disease and cancer: a troubling connection. J Nephrol. 2010;23:253–62.Google Scholar
  11. 11.
    Common Terminology Criteria for Adverse Events v4.0-JCOG. http://www.jcog.jp/doctor/tool/ctcaev4.html.
  12. 12.
    Borazanci E, Von Hoff DD. Nab-paclitaxel and gemcitabine for the treatment of patients with metastatic pancreatic cancer. Expert Rev Gastroenterol Hepatol. 2014;8:739–47.CrossRefGoogle Scholar
  13. 13.
    Masumori N, Kunishima Y, Hirobe M, et al. Measurement of plasma concentration of gemcitabine and its metabolite dFdU in hemodialysis patients with advanced urothelial cancer. Jpn J Clin Oncol. 2008;38:182–5.CrossRefGoogle Scholar
  14. 14.
    Frese KK, Neesse A, Cook N, et al. Nab-paclitaxel potentiates gemcitabine activity by reducing cytidine deaminase level in a mouse model of pancreatic cancer. Cancer Discov. 2012;2:260–9.CrossRefGoogle Scholar
  15. 15.
    Veltkamp SA, Pluim D, van Eijndhoven MA, et al. New insights into the pharmacology and cytotoxicity of gemcitabine and 2′,2′-difluorodeoxyuridine. Mol Cancer Ther. 2008;7:2415–25.CrossRefGoogle Scholar
  16. 16.
    Baur M, Fazeny-Doemer B, Olsen SJ, et al. High dose single-agent paclitaxel in a hemodialysis patient with advanced ovarian cancer: a case report with pharmacokinetic analysis and review of the literature. Int J Gynecol Cancer. 2008;18:564–70.CrossRefGoogle Scholar
  17. 17.
    Yokoyama Y, Futagami M, Higuchi T, et al. Pharmacokinetic analysis of paclitaxel and carboplatin in a patient with advanced ovarian cancer during hemodialysis—case report. Eur J Gynaecol Oncol. 2006;27:437–9.Google Scholar
  18. 18.
    Janus N, Thariat J, Boulsnger H, et al. Proposal dosage adjustment and timing of chemotherapy in hemodialyzed patients. Ann Oncol. 2010;21:1395–403.CrossRefGoogle Scholar
  19. 19.
    Yamamoto T, Miyazaki T, Kurashima Y, et al. A case report of successful chemotherapy with tegafur/gimeracil/oteracil and nab-paclitaxel for gastric cancer with chronic renal failure. Gan To Kagaku Ryoho. 2015;42:735–8.Google Scholar
  20. 20.
    Ide H, Satou A, Hoshino K, et al. Successful management of metastatic urothelial carcinoma with gemcitabine and paclitaxel chemotherapy in a hemodialysis patient. Urol Int. 2011;87:245–7.CrossRefGoogle Scholar
  21. 21.
    Kojima Y, Takahi Y, Ichimaru N, et al. Successful treatment of metastatic urothelial carcinoma arising in a transplanted renal allograft with paclitaxel, cisplatin, and gemcitabine combination therapy: a case report. BMC Res Notes. 2015;8:25.  https://doi.org/10.1186/s13104-015-0982-6.CrossRefGoogle Scholar
  22. 22.
    Von Hoff DD, Ramanathan RK, Borad MJ, et al. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol. 2011;29:4548–54.CrossRefGoogle Scholar
  23. 23.
    Foley RN. Infections in patients with chronic kidney disease. Infect Dis Clin North Am. 2007;21:659–72.CrossRefGoogle Scholar
  24. 24.
    Scheithauer W, Ramanathan RK, Moore M, et al. Dose modification and efficacy of nab-paclitaxel plus gemcitabine vs gemcitabine for patients with metastatic pancreatic cancer: phase III MPACT trial. J Gastrointest Oncol. 2016;7:469–78.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyYokohama Minami Kyosai HospitalYokohamaJapan
  2. 2.Gastroenterological Center, Yokohama City University Medical CenterYokohamaJapan
  3. 3.Department of Nephrology/HypertensionYokohama Minami Kyosai HospitalYokohamaJapan
  4. 4.Gastroenterology DivisionYokohama City University, Graduate School of MedicineYokohamaJapan

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