Long-term Platinum Exposure Linked To Testicular Cancer Survivor Symptoms

The likelihood of long-term platinum-related side effects in testicular cancer patients is predicted by kidney function and cumulative dose

medwireNews: Research has revealed a link between residual levels of platinum in men after testicular cancer treatment and long-term side effects, at least partially mediated by kidney health before and after chemotherapy.

“The relationship between circulating platinum and renal function may act both ways: patients with higher platinum levels have relatively more renal damage, which in turn decreases clearance”, explain Jourik Gietema, from University Medical Centre Groningen in the Netherlands, and co-workers.

Noting that poor renal function can persist for years, and is driven by the number of cycles of bleomycin, etoposide and cisplatin chemotherapy, the team emphasises: “These findings underscore the importance of optimizing renal function before treatment, preserving it during treatment and preventing decline in renal function after completion of cisplatin treatment.”

Serum and 24-hour urine samples taken from 99 testicular cancer survivors, between 1 and 13 years after cisplatin-based chemotherapy were used to build a pharmacokinetic model and determine the area under the curve for 1 to 3 years after treatment (platinum AUC1–3 years) for each patient.

Analysis showed that the platinum AUC1–3 years was significantly related to both cumulative cisplatin dose and the patient’s creatinine clearance before and 1 year after chemotherapy, with patients in the highest quartile for serum creatinine at 1 year showing a higher platinum AUC1–3 years.

Moreover, platinum AUC1–3 years was significantly related to adverse effects, the authors report in the Annals of Oncology.

Patients with Paraesthesia had a higher platinum AUC1–3 years than those without this symptom (30.9 vs 27.0 µg/L per month), giving a significant odds ratio of 1.07 after adjusting for age, body mass index at follow-up and renal function at 1 year.

Multivariate analysis also demonstrated that higher platinum AUC1–3 years was significantly associated with an increased risk of hypogonadism (OR=1.10), hypercholesterolaemia (OR=1.07 for low-density lipoprotein cholesterol) and hypertension (OR=1.10).

“This association between healthy tissue damage in cancer survivors and long-term platinum exposure should be considered during treatment decisions and follow-up care in testicular cancer patients”, Jourik Gietema et al conclude.

“Hence, further research on healthy tissue damage caused by long-term platinum exposure is needed.”

Reference

Boer H, Proost JH, Nuver J, et al. Long-term exposure to circulating platinum is associated with late effects of treatment in testicular cancer survivors. Ann Oncol 2015; Advance online publication 7 September. doi: 10.1093/annonc/mdv369

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