慢性腎不全(血液透析)を伴った進行性尿路上皮癌に対してGemcitabine/Paclitaxel併用療法が奏功した1例

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A 63-year-old man on hemodialysis for chronic renal failure developed a metastatic urothelial carcinoma and was treated with combination chemotherapies. For first line therapy, gemcitabine (GEM) and carboplatin (CBDCA) were given in combination. CBDCA was administered in a target area under the curve of 5.0 mg・min/ml according to the Calvert formula, followed by infusion of GEM at 1,000 mg/m2, with hemodialysis started 1 hour after the end of CBDCA administration. Treatment-related adverse effects were severe, with grade 4 thrombocytopenia and neutropenia. Following two cycles of that therapy, partial response (PR) was obtained for lung metastasis, while progressive disease (PD) was noted in the liver. For second line therapy, GEM and paclitaxel (PAC) were given in combination. PAC was administered at 110 mg/m2 before GEM at 1,000 mg/m2 with hemodialysis given on the interval days. The adverse effect was grade 3 neutropenia, which was considered acceptable. After two cycles of second line therapy, PR was obtained for both lung and liver metastases, and maintained for 6 months. We concluded that GEM/PAC combination therapy is safe and effective for urothelial carcinoma patients undergoing concurrent hemodialysis.