Tailored Chemo Doses Proved Successful for Alport Patient with Breast Cancer in Case Report

A case report about an Alport syndrome patient with end-stage renal disease diagnosed with early breast cancer emphasizes the need for communication between nephrologists and oncologists to tackle both diseases without compromising the patient’s well-being.

The case study, “Treatment of breast cancer in a patient of Alport syndrome-induced chronic renal failure: A triumph story,” appeared in the Journal of Cancer Research and Therapeutics.

Authors describe the case of a 35-year-old woman with Alport syndrome who was diagnosed with triple negative early-stage breast cancer on her right side.

Due to her Alport syndrome, she had chronic kidney failure and was receiving twice-weekly maintenance hemodialysis as she waited for a kidney transplant.

After her breast cancer diagnosis, confirmed by biopsy as intraductal carcinoma, the patient underwent a modified radical mastectomy of the right breast — a surgical procedure for the removal of the entire breast. The surrounding tissue remained cancer-free with no signs of spreading.

She was then referred to the medical oncology department for adjuvant (post-surgery) chemotherapy. However, since she was being treated for end-stage renal disease with medications, the dosage of one of her chemotherapy agents was decreased to reduce the risk of severe toxicity.

And, “nephrotoxic [toxic to the kidneys] anticancer drugs also will require specific monitoring and when available, specific prevention methods to help in reducing the risk for renal toxicity, especially in patients who already have abnormal renal function,” according to the authors.

The oncology team prescribed chemotherapy with three cycles of Adrucil (5-fluorouracil,  500 mg/m² per cycle); Adriamycin (doxorubicin, 50 mg/m² per cycle); Cytoxan (cyclophosphamide, 500 mg/m² per cycle); and Taxotere (docetaxel, 80 mg/m² per cycle).

After consulting with a nephrologist, the dose of Cytoxan was reduced to 50 percent in each cycle. No dose modification was made for Adriamycin, Adrucil, or Taxotere.

“In this case, our clinical challenge was dose reduction of chemotherapeutic agents according to creatinine clearance and timing of [hemodialysis] in each cycle of chemotherapy,” the clinical team wrote. Creatinine clearance is a useful measure to assess kidney function.

The patient’s clinicians reduced her dose of Cytoxan, and each cycle of chemotherapy was given at least 12 hours after hemodialysis.

She tolerated the chemotherapy well without issues of toxicity, and she is undergoing regular follow-up. Twenty months after chemotherapy treatment, there were no signs of cancer recurrence.

“Managing the cancer patients suffering from [end-stage renal disease] requires a combined approach from both oncologist and nephrologists,” the authors said.

“[The] patient can be given an optimum dose of chemotherapy, with proper monitoring of the hydration and other supportive care, with dose modification according to [creatinine clearance],” the report concluded.