Chemotherapy for lung cancer in patients on renal replacement therapy: The Mayo Clinic experience.

Abstract

e20569 Background: The administration of chemotherapy for lung cancer in patients on renal replacement therapy (RRT) is a controversial topic. Most of the available data come from case reports and small series. Herein we present our experience treating these patients. Methods: We retrospectively identified between January 1995 and June 2015 patients who were on RRT at the time of their lung cancer diagnosis. We describe the chemotherapy regimens, dose modifications and timing of hemodialysis, side effects and outcome of these patients. Results: We identified 6 patients on RRT with lung cancer who received targeted therapy or chemotherapy. All were male and the mean age was 63 (range 40-78) years. Treatment regimens, dose modifications and timing of hemodialysis are shown in Table 1. Among 5 patients who received chemotherapy only 1 tolerated all cycles and 2 required treatment delays due to Grade 3-4 adverse reactions. The median overall survival of these patients was 4.2 (range 3-6) months. Conclusions: We present the largest single institution cohort of patients with ESRD and lung cancer treated with chemotherapy. Our experience confirms a grave prognosis and suggests that administration of systemic chemotherapy in these patients is feasible with close monitoring for adverse events, proper dosing of chemotherapy and timing with hemodialysis. The decision to treat must be balanced with toxicity risk. Chemotherapy regimens used at Mayo Clinic in patients with lung cancer. Age, Histology/stage Chemotherapy Dose/Duration 78, SCLC / limited Carboplatin# 225 mg/m2 D1 and Etoposide* 75 mg/ m2 D1 & D3 / 1 cycle 72, Mixed adenocarci noma / IV Paclitaxel* 150 mg/m2 D1 and carboplatin# (AUC of 5) D1 / 5 cycles 51, SCLC / extensive Cyclophosphamide^ 675 mg/m2 D1, vincristine* 1 mg D1 and doxorubicin& 22 mg/m2 D1 / 2 cycles followed by oral etoposide* 50mg twice daily x 1 month 67, Adenocarcinoma / IIIB Paclitaxel* 200 mg/m2 D1, Carboplatin# 150mg/m2 D1/ 2 cycles 40,SCLC / extensive Carboplatin# 150 mg/m2 D1 etoposide* 50 mg/m2 D1-D3 / 6 cycles 67,adenocarcinoma / IIIB Erlotinib* 150mg every 48 hour # start HD 2 hours post dose, * before or after HD, ^ start HD 6-12 hours post dose, $ before HD or on non-HD day, HD : hemodialysis