Medicina pulmonar y respiratoria

Cisplatin Administration at Outpatient Clinics is Safe Compared to the In- Patient Usual Protocol: Findings from a Comparative Study

Abstract

Sébastien Couraud, Marie Coudurier, Anne-Claire Toffart, Marie Destors, Emmanuel Villar, Mélodie Carbonnaux, Gaëlle Fossard, Delphine Farneti, Pierre-Jean Souquet and Denis Moro-Sibilot

Introduction: Cisplatin is widely used in thoracic oncology. Its main limiting adverse effect is renal toxicity. A huge intravenous hydration is known to delivery administration of high-dose cisplatin at out-patient (OP) clinic using a shorter intravenous hydration protocol. However, the safety of this strategy has never been investigated yet. Here, we aimed to provide a comparative study of creatinine clearance levels changes in OP compared to the standard inpatient protocol (IP).

Method: This is a retrospective study comparing two centers: one using the IP standard protocol and the other the OP. We used a general linear model for a confounder-adjusted assessment of the mean difference in creatinine clearance between the two groups.

Results: 227 patients were included (172 in IP and 55 in OP). Pre-cisplatin basal clearance levels were comparable between the two groups. Overall, we found neither clinically relevant nor statistically significant differences in clearance levels change between the two groups regarding each cisplatin cycle. In the multivariable analysis, we found no significant difference in clearance levels among the groups. We found a higher frequency of unexpected hospitalization in IP than in OP (18% vs. 33%; p=0.034) as well as a higher cisplatin dose reduction frequency (16% vs. 39%; p=0.002).

Conclusion: We showed that safe administration of high-dose cisplatin in outpatient clinic is feasible. Emphasize should be put on selection of eligible patients and on the mandatory oral hydration.