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Purpose <p>Anticancer therapy for patients with gastric cancer on hemodialysis is challenging owing to varying pharmacokinetics and a lack of clinical trial data. This study aimed to evaluate the efficacy and safety of the capecitabine plus oxaliplatin (CapeOX) regimen in a 73-year-old male Japanese patient with stage IV gastric cancer (human epidermal growth factor receptor 2 negative) undergoing hemodialysis.</p> Methods <p>The selected chemotherapy regimen was approximately 50% dose of CapeOX (capecitabine 1500&#xa0;mg/day on days 1–14 and oxaliplatin 100&#xa0;mg/day 2-h infusion on day 1) every 3 weeks. Data on plasma drug concentrations, metabolic enzyme genetic polymorphisms, and clinical outcomes were analyzed.</p> Results <p>Anticancer therapy initially controlled the tumor; however, disease progression and cumulative peripheral neuropathy led to discontinuation after 17 cycles (approximately 12 months of treatment). Oxaliplatin exhibited a rebound increase after each dialysis session (dialyzer clearance [CL<sub><i>dial</i></sub>]: median, 44.12 [interquartile range {IQR}: 24.89 − 70.08] mL/min; hemodialysis removal rate: median, 35.98% [IQR: 19.63 − 54.45]. α-fluoro-β-alanine, the final metabolite of capecitabine, accumulated substantially, although approximately half of them was removed by hemodialysis (CL<sub><i>dial</i></sub>: median, 61.32 [IQR: 24.89 − 70.08] mL/min; hemodialysis removal rate: median, 47.98% [IQR: 44.74 − 50.29]). The <i>UPB1</i> intronic variant and a <i>DPYD</i> missense mutation (1627&#xa0;A &gt; G) were detected. The <i>DPYD</i> variant likely influenced 5-fluorouracil metabolism, as its area under the concentration-time curve from 0 to 12&#xa0;h was comparable to the standard dosage.</p> Conclusion <p>These findings suggest that appropriate dose reduction and genetic screening might be considered part of chemotherapy guidance to improve safety and effectiveness for patients with advanced gastric cancer undergoing hemodialysis.</p>

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Pharmacokinetic and pharmacogenomic profile of capecitabine and oxaliplatin in a patient with gastric cancer undergoing hemodialysis: a case report

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Yuki Nakano,
  • Toshinori Hirai,
  • Nao Nishijo,
  • Yugo Uematsu,
  • Yoko Nakajima,
  • Tomomi Ozaki,
  • Ryoko Shibata,
  • Asako Imada,
  • Kazuya Naritomi,
  • Fumihiko Ogata,
  • Naohito Kawasaki,
  • Tadashi Hayama,
  • Masafumi Yasunaga,
  • Kazuhiro Tada,
  • Hirotsugu Hasuwa,
  • Kosuke Masutani

摘要

Purpose

Anticancer therapy for patients with gastric cancer on hemodialysis is challenging owing to varying pharmacokinetics and a lack of clinical trial data. This study aimed to evaluate the efficacy and safety of the capecitabine plus oxaliplatin (CapeOX) regimen in a 73-year-old male Japanese patient with stage IV gastric cancer (human epidermal growth factor receptor 2 negative) undergoing hemodialysis.

Methods

The selected chemotherapy regimen was approximately 50% dose of CapeOX (capecitabine 1500 mg/day on days 1–14 and oxaliplatin 100 mg/day 2-h infusion on day 1) every 3 weeks. Data on plasma drug concentrations, metabolic enzyme genetic polymorphisms, and clinical outcomes were analyzed.

Results

Anticancer therapy initially controlled the tumor; however, disease progression and cumulative peripheral neuropathy led to discontinuation after 17 cycles (approximately 12 months of treatment). Oxaliplatin exhibited a rebound increase after each dialysis session (dialyzer clearance [CLdial]: median, 44.12 [interquartile range {IQR}: 24.89 − 70.08] mL/min; hemodialysis removal rate: median, 35.98% [IQR: 19.63 − 54.45]. α-fluoro-β-alanine, the final metabolite of capecitabine, accumulated substantially, although approximately half of them was removed by hemodialysis (CLdial: median, 61.32 [IQR: 24.89 − 70.08] mL/min; hemodialysis removal rate: median, 47.98% [IQR: 44.74 − 50.29]). The UPB1 intronic variant and a DPYD missense mutation (1627 A > G) were detected. The DPYD variant likely influenced 5-fluorouracil metabolism, as its area under the concentration-time curve from 0 to 12 h was comparable to the standard dosage.

Conclusion

These findings suggest that appropriate dose reduction and genetic screening might be considered part of chemotherapy guidance to improve safety and effectiveness for patients with advanced gastric cancer undergoing hemodialysis.