Background The oncology pharmacist was consulted about the neoadjuvant carboplatin-based chemotherapy regimen for a 59-year-old woman with triple negative stage IIA breast cancer and stage 4 chronic kidney disease. She was undergoing haemodialysis three times a week, on a Tuesday-Thursday-Saturday schedule. The chemotherapy regimen was docetaxel 75 mg/m² IV D1, carboplatin AUC 5 IV D1, Q21D, 6 cycles. The major dose-limiting toxicity of carboplatin is myelosuppression, especially thrombocytopenia. As carboplatin is eliminated mainly through the kidneys, dosage adjustment and timing is required for patients with impaired renal function to prevent severe hematologic toxicity. Carboplatin is removed by haemodialysis.
Purpose To examine the tolerability and safety of carboplatin-based chemotherapy and the applicability of the Calvert formula in a haemodialysis patient with localised breast cancer.
Materials and Methods We reviewed the literature on the pharmacokinetics, efficacy, tolerability and dosage adjustment of carboplatin. In patients on chronic haemodialysis, the issue is how to evaluate the glomerular filtration rate (GFR) in the Calvert formula. We planned the administration of chemotherapy on a non-dialysis day and the following haemodialysis session to occur 24 hours afterwards. The GFR value was assumed to be 0 mL/min and the carboplatin dose calculated was 125 mg.
Results The first two chemotherapy cycles were found to be safe and well tolerated. Neither neutropenia nor thrombocytopenia occurred. After the first cycle, absolute neutrophil nadir count was 5.51 10e-3/mcL and platelet nadir count was 238 10e-3/mcL. Neither allergic or hypersensitivity reactions nor delayed nausea or vomiting occurred. CTCAE grade 3 diarrhoea was controlled with loperamide. Furthermore, a significant reduction in the tumour size was attained.
Conclusions Dosage adjustment and timing of carboplatin-based chemotherapy can result in a safe and well-tolerated preoperative treatment option in a haemodialysis patient with localised breast cancer.
No conflict of interest.
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