[M-VAC therapy in a patient with ureteral carcinoma accompanied by chronic renal failure]

A 63-year-old man with recurrence of ureteral cancer accompanied by chronic renal failure was given M-VAC therapy. Twenty mg of methotrexate was infused on the first day, and 30 mg of cisplatin was infused for one hour at two hours before dialysis on the second day. The total-CDDP level declined in two exponential curves. The half-life of the first phase was 75 minutes and that of the second phase was very long. The free-CDDP level was decreased rapidly and near the level for quantitative analysis after dialysis. Three mg of CDDP was eliminated by dialysis. Seventy-two hours after administration, the MTX level was 0.27 microM, which was at the high-risk level of high-dose therapy. In conclusion, it is considered that CDDP and MTX can be given to a patient with chronic renal failure. However, it is necessary to determine the MTX serum level, even after very low dosages, and to adjust the leucovorin rescue therapy accordingly.