Feasibility of Cancer Chemotherapy in Patients Who Undergo Dialysis Treatment

Abstract

Backgrounds: More than 300,000 patients undergo dialysis treatment today in Japan. In these patients, malignant disease is the third leading cause of death (accounting for 9%) following congestive heart failure and infection. Purpose: To elucidate the feasibility of cancer chemotherapy in patients who undergo dialysis. Methods:We retrospectively reviewed their clinical course of cancer chemotherapy in 22 patients who underwent dialysis from January 2008 to January 2013. Results: The patients consisted of 12 male and 10 female, with the median age of 67 (33-67) years. Their median duration of dialysis was 6 (0-24) years. Underlying diseases for dialysis were as follows: diabetic nephropathy in 9, chronic glomerulonephritis in 7, nephrosclerosis in 2, and other diseases in 4 patients. Twenty-one patients received hemodialysis and one patient peritoneal dialysis. The primary cancer sites included lung in 7, esophagus in 3, breast in 3, head and neck in 2, non-Hodgkin's lymphoma in 2, multiple myeloma in 1, ovary in 1, colon in 1, malignant mesothelioma in 1, and unknown in 1 patient. Treatment regimens were CDDP/ETP in 8, CDDP in 2, CBDCA/PTX in 2, 5FU in 2, R-CHOP in 2, AC followed by PTX in 2, FOLFIRI/Bev in 1, DTX in 1, GEM in 1, Vel/DEX in 1 patient, and radiotherapy was concomitantly given to 8 patients. The median number of chemotherapy cycles was 3, and the best overall response was PR in 6 and CR in 6 patients (response rate 54.5%). The main adverse events: Grade3/4 neutropenia in 14 (63.5%), thrombocytopenia in 6 (27.3%), FN in 6 patients (27.3%), and G3 pancreatitis, G3 heart failure, G3 myocardial infarction and G2 shunt infection in one patient each.With the median follow-up period of 153.5 (10-1455) days, 7 patients died, including 4 early deaths within two months after chemotherapy. The cause of death was cancer progression in 4 and complication in 3 patients. Conclusion: Cancer chemotherapy was feasible in the majority of patients undergoing dialysis. It is an urgent task to establish indication of cancer chemotherapy, its optimal regimen, and complication management in these patients.