局限期小细胞肺癌并发尿毒症患者化疗疗效及血药浓度变化1例报告及文献复习

doi:10.13481/j.1671-587X.20250625

Abstract

Abstract:

Limited-stage small cell lung cancer （SCLC） is a highly malignant and rapidly progressing neuroendocrine tumor， while uremia is a complication of the end-stage of chronic renal failure. The patients with SCLC complicated with uremia have poor treatment tolerance， limited options for anti-tumor treatment regimens， and great difficulty in diagnosis and treatment. This study analyzed one case of a 69-year-old male patient with limited-stage SCLC complicated with uremia （with a history of regular hemodialysis， 3 times per week）， to discuss his first-line treatment regimen， efficacy， and the impact of hemodialysis on the plasma concentrations of the anti-tumor drugs， and reviewed the relevant literature to provide a reference for the treatment of similar patients. The patient was admitted to the hospital due to “cough and hemoptysis for half a month” and was diagnosed with limited-stage SCLC stage ⅢA （T2aN2M0） by computed tomography （CT） and lung puncture biopsy. After discussion by the multi-disciplinary treatment （MDT） team， the patient received 6 cycles of Etoposide（VP-16） + carboplatin chemotherapy combined with adebrelimab immunotherapy， followed by sequential adebrelimab maintenance therapy. The efficacy was evaluated as partial response （PR） and the response is ongoing. During the treatment， level 4 hemoglobin decrease， level 3 neutropenia， and level 2 leukopenia occurred， which were alleviated after symptomatic treatment. The blood concentration monitoring results showed that the plasma concentrations of etoposide and carboplatin increased rapidly during drug infusion， and gradually decreased after the end of infusion. Hemodialysis could rapidly reduce the plasma concentration of carboplatin， but had no significant effect on the plasma concentration of etoposide. Therefore， the immunotherapy combined with reduced-dose chemotherapy regimen is safe and effective for this type of patient. Plasma drug concentration monitoring can be used to observe drug metabolism， but the optimal monitoring time points and clinical value need further study and validation.

Key words: Small cell lung cancer, Uremia, Hemodialysis, Blood concentration, Chemotherapy, Therapeutic effect

CLC Number:

R734.2

Lei TANG,Peinan LIN,Ling ZHANG,Haiyan XU,Fengchun ZHANG. Chemotherapy efficacy and plasma drug concentration changes in patient with limited-stage small cell lung cancer complicated with uremia: A case report and literature review[J].Journal of Jilin University(Medicine Edition), 2025, 51(6): 1687-1694.

Figures/Tables 5

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Tab.1

Tab.2

References 28

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Time	VP-16		Carboplatin
Time	Description	Value[ρ_B/(mg·L^-1)]	Description	Value[ρ_B/(mg·L^-1)]
Day 1
07:30	Before starting the medication	<0.02
08:30	1 h and before the end of medication	13.69	Before starting the medication	0.00
09:30	1 h after the end of the medication	9.02	1 h and before the end of medication	3.84
10:30	2 h after the end of the medication	8.34	1 h after the end of the medication	2.93
11:30	3 hours after the end of the medication	7.50	2 h after the end of the medication	2.85
12:30	4 h after the end of the medication and dialysis begins	6.86	3 h after the end of the medication and dialysis begins	2.70
13:30	5 h after the end of medication, and 1 hour after the start of dialysis	5.57	4 h after the end of medication, and 1 hour after the start of dialysis	0.31
14:30	6 h after the end of medication, and 2 hours after the start of dialysis	4.82	5 h after the end of medication, and 2 hours after the start of dialysis	0.27
15:30	7 h after the end of medication, and 3 h after the start of dialysis	4.38	6 h after the end of medication, and 3 h after the start of dialysis	0.27
16:30	8 h after the end of medication, 4 h after the start of dialysis, and the end of dialysis	3.65	7 h after the end of medication, 4 h after the start of dialysis, and the end of dialysis	0.28
17:30	-	-	8 h after the end of medication and 1 hour after the end of dialysis	0.26
18:30	10 h after the end of medication and 2 h after the end of dialysis	3.32	9 h after the end of medication and 2 hours after the end of dialysis	0.26
Day 2
08:30	24 h after the end of medication and 16 h after the end of dialysis	1.76	-	-
09:30	-	-	24 h after the end of medication and 17 h after the end of dialysis	0.22
Day 3
07:30	48 h after the end of VP-16	0.39	-	-
08:30	-	-	48 h after the end of carboplatin	0.21

Adverse event	Base line	After treatment
ECOG PS	1.00	1.00
Fatigue (Grade)	1.00	3.00
Vomiting (Grade)	0	3.00
WBC (×10⁹ L^-1)	5.48	2.13
Neu (×10⁹ L^-1)	3.64	0.66
HGB (g·L^-1)	124.00	55.00
PLT (×10⁹ L^-1)	181.00	105.00
TBil (μmol·L^-1)	5.40	4.90
DBil (μmol·L^-1)	0.90	1.30
ALT (U·L^-1)	5.00	7.00
AST (U·L^-1)	18.00	14.00
ALB (g·L^-1)	44.6	37.20
ALP (U·L^-1)	98.00	72.00
BUN (mmol·L^-1)	15.20	12.77
SCr (μmol·L^-1)	754.50	580.20
UA (μmol·L^-1)	282.30	192.40

Chemotherapy efficacy and plasma drug concentration changes in patient with limited-stage small cell lung cancer complicated with uremia: A case report and literature review

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