Clinical safety of a 1-h infusion of cisplatin approach in a broad cancer population.

Abstract

IntroductionCisplatin has ubiquitous use throughout many cancer types and is incorporated in various regimens. Nephrotoxicity is a well-known side effect of cisplatin, occurring in up to one third of patients. Early clinical data showed elevated peak concentrations are correlated with increased incidence of nephrotoxicity, suggesting prolonging infusion duration may abate this known toxicity. A recent study showed there was no difference in rates of acute kidney injury (AKI) between rapid (1-h) and standard (3-h) infusions of cisplatin, however, cisplatin was administered inpatient with prolonged and aggressive hydration methods. Therefore, we aimed to compare outcomes in patients who received rapid-infusion vs. standard-infusion cisplatin in the outpatient setting at our institution.MethodsThis single center, pre-post intervention study evaluated outpatient visits between January 2022 and March 2024. Cisplatin was administered over 3-h at Mays Cancer Center, UT Health San Antonio, prior to an institutional practice change to 1-h (rapid infusion) that took place February 2023. The co-primary outcomes were the maximum decrease in eGFR from baseline and the incidence of stage 1 or higher AKI. Secondary outcomes included rates of treatment modification and rates of healthcare resource utilization.ResultsA total of 53 patients with a chemotherapy regimen containing cisplatin met study criteria. Baseline characteristics were similar for the standard (n = 28) and rapid infusion (n = 25) groups. The maximum decrease in eGFR in the standard infusion vs. rapid infusion group did not differ (15.2 vs 18.0 mL/min/1.73 m², respectively; p = 0.89). The incidence of stage 1 or higher AKI was not significantly different between the standard and rapid infusion cohorts (p = 0.13). No differences were identified for the secondary outcomes including rates of regimen modifications or hospitalizations due to AKI or time to AKI in 120 days after the first cisplatin dose.ConclusionIn this pre-post intervention analysis neither occurrence nor severity of nephrotoxicity appeared to be affected by the infusion rate of cisplatin in the outpatient setting. Rapid infusion of cisplatin over 1-h appears to be a feasible option without increased safety risk for patients.