Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report

Our plain-English summary of Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report, by R. Almesned, A.Z. Azzam, A. Aldeheshi, et al (The American Journal of Case Reports, 2023).

The study

• Authors: R. Almesned, A.Z. Azzam, A. Aldeheshi, T.M. Amin
• Journal: The American Journal of Case Reports
• Published: 2023;24:e938192
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment. CASE REPORT In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable. CONCLUSIONS Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.

In plain English

This case report described one 46-year-old woman with recurrent malignant peritoneal mesothelioma and stage 5 chronic kidney disease, treated at a specialist hospital in Riyadh, Saudi Arabia. The article states she had not been exposed to known risk factors for mesothelioma, including asbestos, erionite, radiation or silicate. Before surgery her eGFR, a measure of kidney function, ranged between 5 and 8 mL/min/m2. In November 2021 she had surgery to remove the tumor. During the same operation she received heated cisplatin and doxorubicin inside the abdomen and ifosfamide into a vein. Both cisplatin and ifosfamide can harm the kidneys, so the cisplatin dose was halved and the ifosfamide was given at 75% of the dose. She did not need dialysis during or after surgery. A fluid collection in the pelvis was treated with drainage and antibiotics. At 9 months her kidney function was reported stable (creatinine 478 umol/L, eGFR 8 mL/min/m2), with no chemotherapy-related side effects. The authors concluded that severe kidney impairment might not rule out these drugs in this treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 46-year-old woman with recurrent malignant peritoneal mesothelioma and stage 5 chronic kidney disease, referred to a tertiary care center (King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); operated on November 21, 2021
• Exposure: No asbestos exposure: the article states the patient was not exposed to the well-known risk factors of mesothelioma, including radiation, asbestos, erionite or silicate. The treatment studied was cytoreductive surgery with heated intraperitoneal cisplatin plus doxorubicin and simultaneous intravenous ifosfamide.
• Main results:
  • Before surgery, the patient's eGFR ranged between 5 and 8 mL/min/m2
  • Doses given: 50% of intraperitoneal cisplatin 25 mg/m2 (37.5 mg) plus doxorubicin 7.5 mg/m2 (22.5 mg) over 60 minutes, with a 75% intravenous ifosfamide dose of 1040 mg/m2
  • The patient did not require hemodialysis during or after the operation
  • The postoperative course was complicated by a pelvic collection, managed with drainage and intravenous antibiotics
  • At 9-month follow-up, the patient's kidney function was stable and she had no chemotherapy-related adverse effects; serum creatinine was 478 umol/L and eGFR 8 mL/min/m2
• The authors' conclusion: The authors concluded that severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapy drugs in this combined surgery and chemotherapy treatment. They also said further studies are needed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Cisplatin, Mesothelioma, Peritoneal Mesothelioma, Neoplasm, Prognosis, Cytoreductive Surgery, Doxorubicin.

Related studies

• A 51-Year-Old Woman with Advanced Peritoneal Mesothelioma and Stage 3b Chronic Kidney Disease Treated with Cytoreductive Surgery and Bidirectional Intraperitoneal Cisplatin and Ifosfamide Chemotherapy: A Case Report — M. Alaswad, F. ElKordy, et al. (2023)
• Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin — P. Owusu-Agyemang, R. Arunkumar, et al. (2012)
• Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy — F. Le Roy, M. Gelli, et al. (2017)
• Severe electrolyte disturbances after hyperthermic intraperitoneal chemotherapy: oxaliplatin versus mitomycin C — N.M. Rueth, S.E. Murray, et al. (2011)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)

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