Due to a lack of information, there is no guideline regarding the dosage and timing of chemotherapy in cancer patients undergoing hemodialysis (HD). Therefore, we studied the pharmacokinetics of 5-fluorouracil (5-FU) and oxaliplatin (L-OHP) in cancer patients undergoing HD.
HD patients (HD group) and patients with normal renal function (control group) who had received either modified FOLFOX6 therapy or modified FOLFOX7 therapy were prospectively enrolled. The blood concentrations of 5-FU and 5-FU metabolites, including α-fluoro-β-alanine (FBAL), fluoroacetic acid, and ammonia were measured using inductively coupled plasma-mass spectrometry. The blood concentrations of total and ultrafilterable platinum were measured in the HD group. To estimate the amount of L-OHP removal by dialysis, we also measured the platinum concentration in dialysate.
There were six patients in the HD group and eight patients in the control group. In the HD group, L-OHP was administered just before the HD session in four patients, and on a non-dialysis day in two patients. The amount of L-OHP removal by dialysis was 10% or less of the administered dose, and did not depend on the timing of L-OHP administration. Regarding the 5-FU metabolites, the blood concentration of FBAL was significantly higher in the HD group than in the control group (p
The amount of L-OHP removal by dialysis was up to 10% regardless of the timing of L-OHP administration. Hyperammonemia should be monitored during FOLFOX therapy among HD patients.
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M. Yanagita: Advisory board of Astellas and receives research grants from Astellas, Chugai, Daiichi Sankyo, Fujiyakuhin, Kyowa Hakko Kirin, Mitsubishi Tanabe Pharma Corporation, MSD, Nippon Boehringer Ingelheim, and Torii. All other authors have declared no conflicts of interest.