Adapted adjuvant TC chemotherapy in primary tubal cancer after renal transplantation and chronic hepatitis C infection – a case report

Introduction Application of a platinum-based chemotherapy in patients with impaired renal function or taxanes in case of liver disorders is challenging. Strategies suggested to apply platinum at GFR< 15ml/min include dose reduction with subsequent dialysis. Considering taxanes close monitoring of liver function with temporary discontinuation and subsequent dose reduction is suggested.

Case report 74-year old patient with impaired renal function and chronic hepatitis C infection with the clinical picture of ovarian cancer. Exploratory laparotomy confirmed a primary high-grade serous fallopian tube cancer, FIGO IIIb, with the operative achievement of a macroscopic disease-free status. Adjuvant chemotherapy was adapted to the impaired renal function and hepatic status: paclitaxel 140mg/m² followed by carboplatin 125mg/m² after 48 hours with subsequent dialysis after 20 hours.

Oncological course and outcome Hematotoxicity with anemia and thrombocytopenia, without leukopenia appeared after 3 cycles. Anemia was treated with regular blood transfusions during dialysis. The treatment was discontinued after 5 cycles due to severe thrombocytopenia. Relapse occurred after 10 months. 2^nd line treatment was initiated with liposomal doxorubicin in monotherapy, which was discontinued after 3 cycles due to a severe thrombocytopenia and disease progression, followed by best supportive care.

Discussion In case of combined renal and hepatic impairment we suggest during a combined TC treatment taxanes in reduced dose and the time-delayed application of carboplatin along with a hemato-nephroprotective dialysis within 24 hours. According to the observed hematological toxicity of TC, apart from transfusion of red blood cells, the continuous application of thrombopoietin during the cytotoxic treatment should be considered.

Publication History

Article published online:
07 October 2020