Cisplatin Disposition and Kidney Injury

Cisplatin (cis-diamminedichloroplatinum, Platinol®) is commonly utilized in chemotherapy regimens for the treatment of solid cancers including lung, head and neck, and cervix. Its main mechanism of action is through binding of DNA to form cross-links, leading to arrest of DNA synthesis and replication. A major adverse consequence of cisplatin therapy is acute kidney injury (AKI). It is reported that between 30 and 38 percent of patients develop signs of nephrotoxicity (toxicity in the kidneys) after a single cisplatin dose, despite strategies such as hydration to limit renal exposure. This is problematic for patients as kidney injury can delay further treatment and limit the total number of chemotherapy cycles received, thereby reducing the overall efficacy of cisplatin-containing regimens. Furthermore, it is apparent that cisplatin will remain a central component to the treatment of solid tumors in the foreseeable future. New approaches to identify patients at risk of acute kidney injury (AKI) and prevent its development and progression are urgently needed. Cisplatin causes nausea and vomiting, which requires treatment with 5-HT3 antagonists (5-HT3A) to control. Associations between the clinical use of the 5-HT3A antiemetic drugs and the risk of cisplatin AKI have recently been discovered. This study will interrogate relationships between 5-HT3A drugs (granisetron, ondansetron, and palonosetron) and cisplatin AKI.

Inclusion criteria

• Male or female patient prescribed cisplatin at a dose of >25mg/m^2
• Age 18-80 years
• Hemoglobin >/=9 g/dl
• No consumption of grapefruit juice or alcohol within 7 days
• No history of alcohol consumption of >14 drinks/week
• No history of organ transplantation or kidney dialysis
• Willingness to comply with study
• Not pregnant or lactating
• No changes in chronic medications within 2 weeks
• Estimated glomerular filtration rate (eGFR) > 60 ml/min^2
• Normal liver function (ALT and AST <2x ULN)

Exclusion criteria

• Diagnosis of kidney cancer
• Previous exposure to platinum-based chemotherapy with the exception of one previous dose as part of the current course
• Herbal supplement use beyond marijuana
• Exposure to other known nephrotoxins (including contrast agents) within the previous 2 weeks
• Severe gastrointestinal disease with fluid losses
• Diagnosis of a rapidly progressive glomerulonephritis
• Allergy or contraindication to 5-HT3 Antagonists