Chemotherapy for primary mediastinal yolk sac tumor in a patient undergoing chronic hemodialysis: a case reportReportar como inadecuado

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Journal of Medical Case Reports

, 11:43

First Online: 16 February 2017Received: 04 October 2016Accepted: 17 January 2017DOI: 10.1186-s13256-017-1213-7

Cite this article as: Hirakawa, H., Nakashima, C., Nakamura, T. et al. J Med Case Reports 2017 11: 43. doi:10.1186-s13256-017-1213-7


BackgroundThe safety and efficacy of chemotherapy for patients undergoing concomitant hemodialysis have not been fully established and optimal doses of anti-cancer drugs and best timing of hemodialysis remains unclear. Although chemosensitive cancers, such as germ cell tumors, treated with chemotherapy should have sufficient dose intensity maintained to achieve the desired effect, many patients with cancer undergoing hemodialysis might be under-treated because the pharmacokinetics of anti-cancer drugs in such patients remains unknown.

Case presentationWe describe a 31-year-old Japanese man with a mediastinal yolk sac tumor treated with surgery followed by five cycles of chemotherapy containing cisplatin and etoposide while concomitantly undergoing hemodialysis. The doses of these agents used in the first cycle were 50% of the standard dose of cisplatin 10 mg-m and 60% of the standard dose of etoposide 60 mg-m on days 1 through to 5; the doses were subsequently escalated to 75% with both agents. Hemodialysis was started 1 hour after infusions of these agents. Severe hematological toxicities were observed despite successful treatment. During treatment with concurrent hemodialysis, pharmacokinetic analysis of cisplatin was performed and its relationship with adverse effects was assessed. Compared with patients with normal renal function, the maximum drug concentration was higher, and concentration increased in the interval between hemodialysis and the subsequent cisplatin infusion, resulting in a higher area under the curve despite a reduction in the dose to 75% of the standard regimen.

ConclusionsBecause of the altered pharmacokinetics pharmacodynamics status of patients with renal dysfunction undergoing hemodialysis, pharmacokinetics pharmacodynamics analysis is deemed to be helpful for effective and safe management of chemotherapy in patients undergoing hemodialysis.

KeywordsMediastinal yolk sac tumor Hemodialysis Renal insufficiency Cisplatin Pharmacokinetics AbbreviationsAFPAlpha-fetoprotein

AUCArea under the curve

BEPBleomycin, etoposide, and cisplatin

β-hCGBeta-human chorionic gonadotropin

BUNBlood urea nitrogen


CmaxMaximum concentration


CTComputed tomography

G-CSFGranulocyte-colony stimulating factor


IGCCCInternational Germ Cell Consensus Classification




PLAPPlacental alkaline phosphatase

VIPIfosfamide, etoposide, and cisplatin

Autor: Haruki Hirakawa - Chiho Nakashima - Tomomi Nakamura - Masanori Masuda - Taro Funakoshi - Shunsaku Nakagawa - Takahiro Horim


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