P1-120Gemcitabine/Cisplatin therapy for an urothelial carcinoma patient undergoing hemodialysis: a case report

Abstract Background Gemcitabine/Cisplatin (GC) therapy is first-line chemotherapy for advanced urothelial carcinoma (UC). The Renal Impairment Clinical Practice Guidelines 2016 suggest that, Cisplatin (CDDP) may be administered by up to 50% of standard dose for patients with hemodialysis (HD) because of the renal toxicity. The evidence is, however, scanty to evaluate safety. We report a case of GC therapy for a UC patient undergoing HD. Patient A 80-years old male with bilateral papillary UC had a total renal ureteral resection and underwent HD. Two courses of adjuvant GC therapy were to be performed. The standard dose of Gemcitabine (GEM) and 50% of standard dose of CDDP were administered on the same day based on CDDP and GEM interview form and literature for HD patients. HD started 6 hours after GEM administration and 1 hour after CDDP administration. The volume of infusion was 600 mL; diuretics were not used. Side effects were evaluated according to Common Terminology Criteria for Adverse Events v4.0. Results In first course, Grade 4 side effects were observed: leukopenia, neutropenia and thrombocytopenia. They were treated by granulocyte-colony stimulating factor (G-CSF) administration and platelet transfusion. No febrile neutropenia was observed. Because the second course was administered without reducing the doses, G-CSF was prophylactically administered, and the Grade 4 side effects were reduced to Grade 3. No relapse was observed by now. Conclusion We could performed GC therapy safety for a patient with advanced UC undergoing HD by managing adverse event adequately.