AB146. Adjuvant chemotherapy with gemcitabine plus cisplatin for kidney transplant patients with locally advanced transitional cell carcinoma: a single-center experience

OBJECTIVE: The purpose of the present study was to evaluate the effects and safety of adjuvant chemotherapy with gemcitabine plus cisplatin in kidney transplant patients with locally advanced transitional cell carcinoma. METHODS: A total of 22 kidney transplant patients with locally advanced transitional cell carcinoma were assessed. Eleven patients who underwent surgery and adjuvant chemotherapy were enrolled in the study. They were compared with 11 matched patients who were treated with surgery alone. The chemotherapy regimen was gemcitabine 800 mg/m(2) on days 1, 8 and 15 and cisplatin 70 mg/m(2) on day 2. A single treatment cycle lasted 28 days. Due to the potential concerted reaction between the immunosuppressant regimen and the chemotherapeutic agents, drug toxicities were closely observed, and a dose reduction of the chemotherapeutic agents was planned, according to the toxicity grade. There was a 75% drug dose reduction for grade 2 hematological toxicities and grade 1 nephrotoxicity. There was a 50% drug dose reduction for grade 3 hematological toxicity and grade 2 nephrotoxicity. Patients who developed grade 4 hematological toxicity or grade 3–4 nephrotoxicities were omitted. RESULTS: Eleven patients completed a total of 29 cycles. At a median follow-up time of 21 months, the mean overall survival time was longer than that of the observation group (P=0.043). The incidence of hematological toxicities was higher, resulting in a dose reduction of the chemotherapeutic agents in 45.5% of the patients. Gastrointestinal reactions were most common in non-hematologic toxicities. Grade 1 nephrotoxicity was found in three patients, and no other grade of nephrotoxicity was observed. Neither serum creatinine nor blood urea nitrogen was obviously deteriorated during chemotherapy. CONCLUSIONS: Our study data suggested that kidney transplant patients with locally advanced transitional cell carcinoma may derive an overall survival benefit from the administration of adjuvant chemotherapy with gemcitabine plus cisplatin after surgery. The drugs toxicities were acceptable, and the nephrotoxicity was mild.