Chemotherapy in cancer patients undergoing haemodialysis: a nationwide study in Japan

Taro Funakoshi; Takahiro Horimatsu; Michio Nakamura; Koichi Shiroshita; Koichi Suyama; Masashi Mukoyama; Takuro Mizukami; Tsutomu Sakurada; Eishi Baba; Kazuhiko Tsuruya; Akira Nozaki; Kensei Yahata; Yukinori Ozaki; Yoshifumi Ubara; Hisateru Yasui; Akihiro Yoshimoto; Shingo Fukuma; Naoya Kondo; Takeshi Matsubara; Kazuo Matsubara; Shunichi Fukuhara; Motoko Yanagita; Manabu Muto

doi:10.1136/esmoopen-2017-000301

Chemotherapy in cancer patients undergoing haemodialysis: a nationwide study in Japan

ESMO Open. 2018 Feb 23;3(2):e000301. doi: 10.1136/esmoopen-2017-000301. eCollection 2018.

Authors

Taro Funakoshi¹, Takahiro Horimatsu¹, Michio Nakamura², Koichi Shiroshita³, Koichi Suyama⁴, Masashi Mukoyama⁵, Takuro Mizukami⁶, Tsutomu Sakurada⁷, Eishi Baba⁸, Kazuhiko Tsuruya⁹, Akira Nozaki¹⁰, Kensei Yahata¹¹, Yukinori Ozaki¹², Yoshifumi Ubara¹³, Hisateru Yasui¹⁴, Akihiro Yoshimoto¹⁵, Shingo Fukuma¹⁶, Naoya Kondo¹⁷, Takeshi Matsubara¹⁷, Kazuo Matsubara¹⁸, Shunichi Fukuhara¹⁹, Motoko Yanagita¹⁷, Manabu Muto¹

Affiliations

¹ Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
³ Division of Nephrology, Sapporo City General Hospital, Sapporo, Japan.
⁴ Kumamoto University Hospital Cancer Center, Kumamoto University, Kumamoto, Japan.
⁵ Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
⁶ Department of Clinical Oncology, St Marianna University School of Medicine, Kawasaki, Japan.
⁷ Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
⁸ Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁹ Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁰ Department of Clinical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
¹¹ Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
¹² Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
¹³ Nephrology Center, Toranomon Hospital, Tokyo, Japan.
¹⁴ Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁵ Department of Nephrology, Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁶ Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁷ Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁸ Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan.
¹⁹ Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.

Abstract

Background: Cancer is a major cause of death in patients undergoing haemodialysis. However, information about the actual clinical practice of chemotherapy for patients with cancer undergoing haemodialysis is lacking. We conducted a nationwide survey using questionnaires on the clinical practice of chemotherapy for such patients.

Patients and methods: The nationwide survey included patients undergoing haemodialysis who were subsequently diagnosed with cancer in 20 hospitals in Japan from January 2010 to December 2012. We reviewed their clinical data, including cancer at the following primary sites: kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast. The questionnaires consisted of the following subjects: (1) patient characteristics; (2) regimen, dosage and timing of chemotherapy; and (3) clinical outcome.

Results: Overall, 675 patients were registered and assessed for main primary cancer site involvement. Of 507 patients with primary site involvement, 74 patients (15%) received chemotherapy (44 as palliative chemotherapy and 30 as perioperative chemotherapy). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients), platinum (8 patients) and taxane (8 patients), and the dosage and timing of these drugs differed between institutions; however, the dosage of molecular targeted drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients receiving palliative chemotherapy was 13.0 months (0.1-60.3 months). Three patients (6.8%) died from treatment-related causes and nine patients (20%) died of causes other than cancer. Of the 30 patients who received perioperative chemotherapy, 6 (20%) died of causes other than cancer within 3 years after the initiation of chemotherapy.

Conclusion: Among the haemodialysis patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. Indications for the use of chemotherapy in patients undergoing haemodialysis should be considered carefully.

Keywords: anticancer drug; chemotherapy; dosage adjustment; end-stage renal disease; hemodialysis.