dopamine may decrease nephrotoxicity in patients receiving high dose ifosfamide l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide PowerPoint Presentation
Download Presentation
Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide

Loading in 2 Seconds...

play fullscreen
1 / 16

Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide - PowerPoint PPT Presentation


  • 243 Views
  • Uploaded on

Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide. L Johnetta Blakely, SR Patel, PF Thall, X Wang, TA Simmons, JL Beach, TL Armen, LL Chen, MA Burgess, JC Trent, and RS Benjamin UT MD Anderson Cancer Center Houston, United States. Background.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide' - lotus


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
dopamine may decrease nephrotoxicity in patients receiving high dose ifosfamide

Dopamine May Decrease Nephrotoxicity in Patients Receiving High-Dose Ifosfamide

L Johnetta Blakely, SR Patel, PF Thall,

X Wang, TA Simmons, JL Beach, TL Armen,

LL Chen, MA Burgess, JC Trent, and

RS Benjamin

UT MD Anderson Cancer Center

Houston, United States

background
Background

Ifosfamide is one of the most commonly used and most effective chemotherapeutic agents for sarcoma

Complications with high-dose ifosfamide:

  • Renal Toxicity
  • Neurotoxicity
  • Neutropenia / Fever
background3
Background

Dopamine

  • Low doses have been shown to increase blood flow and GFR
  • Some evidence suggests a renal protective effect in cancer patients receiving immunotherapy
giving dopamine with ifosfamide rationale and possible benefits
Giving Dopamine with Ifosfamide:Rationale and Possible Benefits
  • Decrease in “subclinical” nephrotoxicity
  • Decrease in clinical nephrotoxicity
  • Decrease in other adverse side effects
  • Decrease in length of hospital stay
  • Increase in the initial dose and possibly subsequent doses of ifosfamide
  • Increase in cure rate and expected survival
methods
Methods
  • Randomized phase III study in progress, with 34/36 patients enrolled
  • 2 patients were excluded from this analysis due to abnormal baseline renal function
  • The full data, including creatinine level over 3 courses of therapy, on 29 patients currently are available. These data were used for this statistical analysis
methods chemotherapy
Methods: Chemotherapy

Ifosfamide

2000 mg/m2 in 500 ml NS over 2 hr q 12 h x 7 doses

Mesna

  • 400 mg/m2 mixed w. first Ifosfamide dose
  • Simultaneously, start mesna2400mg/m2 in 2 liters D5W w. 150 mEq/l Sodium Acetate + 20 mEq/l K Acetate over 24 hrs daily x 4 days via pump

Dopamine

  • Patients randomized to receive or not receive dopamine 3mcg/kg/min after 4 hours of IV fluids
methods chemotherapy7
Methods: Chemotherapy

IV Fluids

  • D5W + 150 mEq /l Sodium Acetate + 4 mEq/l MgSO4 + 40 mEq / l K Acetate + 20 mEq / l KCl at 125 ml / hr for 4 hr prior to and continuing with chemotherapy and mesna
  • At completion of MESNA infusion, increase IV fluid rate to 250 ml / hr
  • Daily adjustments to keep patient alkaline and balance electrolytes
patient characteristics
Patient Characteristics
  • 29 patients randomized
    • 13 (45%) received dopamine
    • 16 (55%) received no dopamine
  • Age
    • Median 35 years
    • Range 18 - 62
  • Sex
    • 10 (34%) females
    • 19 (66%) males
statistical methods
Statistical Methods

Daily creatinine level was measured during and immediately after ifosfamide over 3 cycles of therapy, 21 days per cycle

A longitudinal mixed effects linear regression model was fit, accounting for :

  • Variation of Creatinine, over time within cycle
  • Patient Age
  • Baseline Creatinine
  • Treatment (Dopamine vs. No Dopamine)
  • Within-Patient Correlation, among the repeated creatinine measurements
results

Predicted Creatinine Levels Over Cycle 1

for a 30-year-old Patient

with Baseline Creatinine Level 0.8

Results

95% confidence intervals given by vertical lines

slide11

Predicted Creatinine Levels for the Dopamine and No Dopamine Groups

by Age (30 vs 52 ) and Baseline Creatinine Level (0.8 vs 1.1 ) in Cycle 1

No Dopamine

Dopamine

slide12

Predicted Creatinine Levels for the Dopamine and No Dopamine Groups

by Age (30 vs 52 ) and Baseline Creatinine Level (0.8 vs 1.1 ) in Cycle 2

No Dopamine

Dopamine

slide13

Predicted Creatinine Levels for the Dopamine and No Dopamine Groups

by Age (30 vs 52 ) and Baseline Creatinine Level (0.8 vs 1.1 ) in Cycle 3

No Dopamine

Dopamine

statistical results
Statistical Results

Fitted Linear Mixed Model for Creatinine Levels

*A negative sign corresponds to a lower creatinine level

ignoring baseline creatinine
Ignoring Baseline Creatinine

Accounting for Baseline Creatinine

Dopamine

No

Dopamine

No Dopamine

Dopamine

P = 0.715

P = 0.014

conclusions
Conclusions
  • Dopamine may offer significant protection from ifosfamide nephrotoxicity
  • The relative magnitude of the effect of baseline creatinine on subsequent creatinine levels is approximately 10-fold that of dopamine
  • If we had ignored baseline creatinine in our model, we would have missed the beneficial effects of dopamine