Successful use of cisplatin to treat metastatic seminoma during cisplatin-induced acute renal failure

Article Abstract:

Cisplatin is a potent chemotherapeutic agent that plays a key role in many cancer treatments. Unfortunately, it has many potentially serious side effects which often limit the amount of cisplatin that can be administered. One of these side effects is kidney toxicity. Usually, acute kidney failure resulting from cisplatin treatment indicates that the drug must be halted. However, the case of a 34-year-old man revealed that this may not necessarily be so. The patient developed abdominal pain and weight loss, and was found to have a large tumor in his back. Biopsy revealed the tumor to be a seminoma, a tumor that develops in men from germ cells. Cisplatin is generally the chemotherapeutic agent of choice for seminoma. The patient's tumor was measurably shrinking 41 days after the start of treatment when he developed septicemia. (Septicemia results from bacteria in the blood and, in this case, was most likely the result of a rectal biopsy.) The patient rapidly developed acute kidney failure which was believed to be due to the combined effects of cisplatin and septicemia. Intermittent dialysis was required. Ninety-three days after the start of cisplatin treatment, ultrasonic images revealed the recurrence of the cancer, as well as the appearance of a new tumor mass. It was decided to return the patient to cisplatin therapy while simultaneously placing him on dialysis. Mannitol and intravenous saline were administered in an effort to protect the kidneys from further damage during treatment. The patient was able to achieve a complete remission as a result of the cisplatin treatment and remains free of disease after three years. The patient's kidneys have recovered to useful function. While it would be unwise to generalize on the basis of this one observation, this case does illustrate that, when the patient's life may be at stake, acute kidney failure does not necessarily preclude further, and ultimately successful, treatment with cisplatin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Germ cell tumors, Germinoma, Acute renal failure, Acute kidney failure

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The use of probenecid as a chemoprotector against cisplatin nephrotoxicity

Article Abstract:

The doses of chemotherapeutic agents that can be administered to a cancer patients are invariably limited by their toxic effects. One of the toxic effects that limits the dose of cisplatin is nephrotoxicity, or toxic damage to the kidney. While the kidney toxicity caused by cisplatin is unlikely to be life-threatening, the fact that it limits the dose of cisplatin has important implications for the health of the patient. Previous research has indicated that the kidney damage caused by cisplatin is actually caused by the drug being excreted by the kidney. This suggests that if the excretion of cisplatin could be reduced, so could the nephrotoxicity. Since the use of chemoprotective agents is fraught with the danger of protecting the cancer as well as the patient, it is especially appealing to use an agent that works at the level of the kidneys, since such an agent is unlikely to affect the cytotoxicity of the cisplatin for the cancer cells themselves. One potentially chemoprotective agent is probenecid, which acts upon the tubules of the kidney. After this agent was shown to successfully prevent cisplatin-induced nephrotoxicity in rats, a Phase I trial in 36 cancer patients was organized. One gram of probenecid was given every six hours, beginning 24 hours prior to the start of cisplatin chemotherapy and ending 24 hours after the end of the chemotherapy. Kidney toxicity was not observed in any patient. However, as might be expected, the probenecid had no effect on any toxic effects outside the kidneys, and toxic effects to the sense of hearing became the dose-limiting side effect. The study indicates that probenecid is indeed effective in the reduction of nephrotoxicity due to cisplatin. Since probenecid has no toxic effects of its own, it warrants further investigation as a chemoprotectant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Kidneys, Kidney, Kidney diseases, Probenecid

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Low prevalence of cisplatin-induced neuropathy after 4-day continuous infusion in head and neck cancer

Article Abstract:

Cisplatin has been reported to cause peripheral nerve damage as an occasional side effect. Some studies, which attempted to determine the actual incidence of peripheral neuropathy, have reported a high frequency, from 52 to 92 percent of patients evaluated clinically, and in 55 percent of patients evaluated using electrophysiological measurements. Cisplatin continuously infused for the treatment of head and neck cancer does not seem to produce such frequent neuropathic effects. Careful electrophysiological measurements were taken in 52 patients undergoing treatment for squamous cell carcinoma of the head and neck. Measurements were made of nerve conduction velocities and of the soleus muscle reflex. A slowing of conduction velocity in sensory nerves and an increase in the latency of the soleus reflex revealed the presence of peripheral neuropathy in only 14 percent of the patients studied, an incidence considerably lower than reported in some other studies. There are two main differences in the present study that may account for this discrepancy. The continuous infusion drug delivery used for this group of patients can dispense the same total drug amount without reaching the high peak blood concentrations observed following discrete injections. The lower peak concentrations may contribute to reduced toxic effects. Furthermore, other studies often involve the use of cisplatin in combination with other cytotoxic drugs. The present study evaluated the neurotoxicity of cisplatin alone; the combination of other substances such as doxorubicin may increase the toxic effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Peripheral nerve diseases, Peripheral nervous system diseases, Head and neck cancer

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