Prophylactic Effect of Premedication with Intravenous Magnesium on Renal Dysfunction in Preoperative Cisplatin-Based Chemotherapy for Esophageal Cancer

Abstract

Background: Magnesium premedication is reported to have a significant effect on reducing cisplatin-induced nephrotoxicity in several types of cancer. However, the effectiveness of magnesium administration in reducing nephrotoxicity remains unknown in esophageal cancer, especially regarding neoadjuvant therapy.

Methods: Between January 2017 and January 2019, 105 patients who underwent neoadjuvant chemotherapy followed by surgery were included in this study. Of these patients, 40 received intravenous magnesium premedication (magnesium group), whereas the remaining 65 did not (control group). We investigated the -association between magnesium premedication and chemotherapy-related nephrotoxicity.

Results: Baseline characteristics, such as age, body mass index, clinical stage, comorbidity, and pretreatment renal function, were not significantly different -between the magnesium and control groups. Clinical and -pathological responses were similar between the 2 groups. Regarding chemotherapy-related toxicity, there were no significant differences in hematological side effects, such as anemia, thrombopenia, and neutropenia, between both groups. However, nephrotoxicity of grade 2 and higher was significantly less frequent in the magnesium group than in the control group (2.5 vs. 21.5%, p = 0.0026), although there was no significant difference in the incidence of other nonhematological adverse events, such as nausea and diarrhea. Multivariate analysis indicated magnesium premedication and heart disease as independent factors associated with cisplatin-induced nephrotoxicity (p = 0.0026 and p = 0.0424, respectively).

Conclusion: We showed that intravenous magnesium premedication exerts a protective effect against renal dysfunction in esophageal cancer patients undergoing neoadjuvant chemotherapy including high-dose cisplatin. Large-scale prospective studies are needed to confirm the effect of magnesium premedication on reducing nephrotoxicity in esophageal cancer patients undergoing neoadjuvant therapy.

Keywords: Cisplatin; Esophageal cancer; Magnesium premedication; Neoadjuvant chemotherapy.