Chemotherapy in patients with advanced gastrointestinal tumors and end-stage chronic kidney disease. Brief literature review and clinical case reports

Background. Patients with chronic kidney disease (CKD) on hemodialysis (HD) often face difficulties in the use of chemotherapy (CT), since most antitumor drugs have nephrotoxicity, which can worsen the condition of the kidneys. At the same time, there are no clear recommendations for the management of patients in this category. The article presents current information on the management of patients receiving CT against the background of HD, assesses the possibility of CT in patients with gastrointestinal tract (GIT) tumors against the background of the end-stage CKD receiving HD, and gives recommendations for individual treatment adjustment using the example of two clinical cases of patients with end-stage CKD receiving HD and CT.

Results. Both patients showed positive dynamics: the first patient had a partial tumor response to treatment, the second patient had stabilization of the process. However, the treatment was accompanied by various manifestations of toxicity, including stomatitis, asthenia and diarrhea, which required further dose adjustment. An important role was played by the pharmacokinetics of antitumor drugs, which was taken into account when prescribing CT in the conditions of program HD.

Discussion. CT in patients with CKD on HD can be successful if the pharmacokinetics of the drugs, regular monitoring and dose adjustment are taken into account. Platinum derivatives and 5-fluorouracil, used in the treatment of gastrointestinal tumors, require special attention in conditions of renal failure. Nevertheless, dose adjustment and HD before and after drug administration provide achieving therapeutic efficacy while minimizing side effects.

Conclusion. The end-stage CKD and the need for program HD are not an absolute contraindication to CT in patients with gastrointestinal tumors. An individual approach to each patient, dose adjustment and careful monitoring of the patient’s condition provide achieving positive results in antitumor treatment.