Systemic Treatment for Gynecological Cancer Patients Undergoing Hemodialysis

Figures & data

Table 1 Summary of the Chemotherapeutics for Gynecological Malignant Tumors in Hemodialysis Patients

Medication	Molecular Mass (Da)	Elimination	Half-Life	Dose Reduction in Hemodialysis Patients	Safety	Administration in Relation to Hemodialysis Session	Literature
Cisplatin	300	Almost all with urine	5h	Recommended dose reduction by 25–50%	Increased risk of myelotoxicity	Before HD	[9]
Carboplatin	371.3	Almost all with urine	6h	AUC (mg/mL × min) × 25	Increased risk of myelotoxicity	Nondialysis day or perform HD 12–24 hours later	[10,11]
Nedaplatin	305.2	Almost all with urine	5h	Recommended dose reduction by 50%	Safe	Before HD	[12]
Oxaliplatin	397.29	Most with urine	5h	Recommended dose reduction by 30%	No data	After HD sessions or on non-dialysis days	[13]
Paclitaxel	853.9	Primarily with liver into bile	5h	No dose adjustment required	Safe	Before or after HD	[14]
Docetaxel	807.9	75% with faeces, 6% with urine	4min	No dose adjustment required	Safe	Before or after HD	[15]
Doxorubicin	762.76	15% with urine	20–48h	No dose adjustment required	Increased risk of cardiotoxicity	After HD or on nondialysis days	[5]
Epirubicin	543.53	10% with urine	1.2h	No dose adjustment required	Increased risk of cardiotoxicity	After HD or on nondialysis days	[5]
Pegylated liposomal doxorubicin	579.99	Similar to Doxorubicin	50h	No dose adjustment required	Increased risk of cardiotoxicity	After HD or on nondialysis days	[16,17]
Cyclophosphamide	261.1	70–80% with hepatic enzymes, 30% to 60% with urine	7h	No dose adjustment required	Haemorrhagic cystitis	After HD on nondialysis days	[5,18]
Ifosfamide	261	Extensively with hepatic enzymes	7–15h	Not recommended	Haemorrhagic cystitis	No data	[19,20]
Gemcitabine	263	90% with urine	4–11h	No dose adjustment required	Safe	6–12 hours before HD	[21]
Topotecan	421.4	20% with urine	3–6h	50–75% reduction in the initial dose	Safe	After HD sessions or on non-dialysis days	[9]
Irinotecan	586.7	Up to 20% with urine	6–12h	No dose adjustment required	Safe	Before HD	[22]
Pemetrexed	427.4	70–90% with urine	3.5h	Not recommended	No data	No data	[9]
Methotrexate	454.4	90% with urine	3–15h	No dose adjustment required	Safe	Before HD	[23]
5-Fluorouracil	130	Primarily metabolized in liver,	20min	No dose adjustment required	Safe	After HD or on nondialysis days	[8,24]
Vincristine	825	Primarily with liver into bile	19h	No dose adjustment required	Safe	After HD or on nondialysis days	[25]
Bleomycin	1416	Less than 20% with urine	9h	Not recommended	No data	No data	[26]
Etoposide	588	56% with urine, 44% with bile and stool	4–11h	Reduce by 50% or no dose adjustment required	Safe	Before or after HD	[27]

Table 2 Summary of the Targeted Therapeutics and Immunotherapeutic for Gynecological Malignant Tumors in Hemodialysis Patients

Medication	Molecular Mass (Da)	Elimination	Half-Life	Dose in Hemodialysis Patients	Safety	Administration in Relation to Hemodialysis Session	Literature
Bevacizumab	149k	Proteolytic catabolism	20d	No dose adjustment required	Safe	Before or after HD	[50]
Anlotinib	407.4	Cytochrome P450	93–116h	No data	No data	No data	[51]
Olaparib	435	44% with urine, 42% with faces	5–11h	No data	No data	No data	[52]
Talazoparib	380	65% with urine, 20% with faces	90h	No data	No data	No data	[53]
Nivolumab	146k	Proteolytic catabolism	27d	No dose adjustment required	Safe	Before or after HD	[54]
Pembrolizumab	149k	Proteolytic catabolism	26d	No dose adjustment required	Safe	Before or after HD	[55]
Atezolizumab	145k	Proteolytic catabolism	27d	No dose adjustment required	Safe	Before or after HD	[54]
Ipilimumab	148k	Proteolytic catabolism	15d	No dose adjustment required	Safe	Before or after HD	[56]
Dostarlimab		Proteolytic catabolism		No data	No data	No data	[57]

Table 3 Summary of the Endocrine Therapeutics for Gynecological Malignant Tumors in Hemodialysis Patients

Medication	Molecular Mass (Da)	Elimination	Half-Life (h)	Dose Reduction in Hemodialysis Patients	Safety	Administration in Relation to Hemodialysis Session	Literature
Anastrozole	293.4	85% with faeces, 11% with urine	41	No dose adjustment required	Safe	After HD	[24]
Letrozole	285.3	Primarily with liver	42	No dose adjustment required	Safe	No data	[61]
Exemestane	296.4	1% with urine	24	No data	No data	No data	[62]

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