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Topotecan disposition in an anephric child
Lisa C Iacono1, Denise Adams, Alan C Homans
1Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Journal of Pediatric Hematology/Oncology
|September 3, 2004
Summary
Topotecan disposition was studied in an anephric child with Wilms tumor undergoing hemodialysis. The chemotherapy drug's clearance was minimally affected by hemodialysis, showing similar levels to patients without renal failure.
Area of Science:
- Pharmacokinetics
- Pediatric Oncology
- Nephrology
Background:
- Limited data exist on topotecan pharmacokinetics in renal insufficiency.
- No data were available for anephric patients, particularly children.
Observation:
- A single pediatric patient with Wilms tumor and no renal function was studied.
- The patient received combination therapy with topotecan and cyclophosphamide.
- Hemodialysis was administered on days 2 and 4 of each 5-day topotecan cycle.
Findings:
- Topotecan lactone clearance was 15.5 L/h/m off hemodialysis and 18.7 L/h/m on hemodialysis.
- Topotecan clearance was minimally impacted by hemodialysis.
- The observed clearance was comparable to that in pediatric patients with normal renal function.
Implications:
- Topotecan may be safely administered to anephric pediatric patients undergoing hemodialysis.
- These findings support further investigation into topotecan dosing in pediatric patients with end-stage renal disease.
- Understanding topotecan disposition is crucial for optimizing chemotherapy in vulnerable pediatric populations.