Déséquilibre de la composition corporelle chez les patients atteints de cancer : conséquences sur l’estimation de la fonction rénale et la toxicité du carboplatine

Abstract : Purpose: carboplatin clearance is correlated with Glomerular Filtration Rate (GFR) and usually estimated with creatinine clearance using Cockcroft-Gault (CG) formula. Because plasma creatinine level is highly correlated with muscle mass, we hypothesized that an abnormal body composition with a low lean body mass (LBM) percentage ((LBM / weight) ×100) may result in inadequate carboplatin dosing. Serum cystatin C (cysC) is an alternative marker of GFR, not affected by muscle mass. We aimed at investigating the influence of total LBM and LBM percentage on GFR calculation, using creatinine (CrCl) or cysC (GFRcysC-creat) in cancer patients. Methods: pretreatment serum creatinine and cysC were prospectively measured in consecutive patients. CrCl (CG), GFRcysC-creat (CKD-EPI creatinine-cystatin), and LBM (CT-scan) were calculated. Severe thrombocytopenia post carboplatin were analyzed. Results: in 131 patients without renal insufficiency, LBM was correlated with creatinine (r =0.30, p <0.005) but not with cysC (p =0.43). In patients with the lowest LBM percentage, the CrCl was significantly higher than GFRcysC-creat indicating an overestimation of GFR with creatinine (p =0.0004). In 24 patients treated with carboplatin +/- paclitaxel, the risk of severe thrombocytopenia was associated with lower LBM percentage (p =0.0002) and higher CrCl/GFRcysC-creat ratio (p =0.006). By ROC analysis, the CrCl/GFRcysC-creat ratio threshold predicting severe thrombocytopenia was 1.23. Conclusions: a low LBM percentage increases the risk of inadequate CrCl calculation by CG formula and carboplatin overdosage. High CrCl/GFRcysC-creat ratio allows these patients identification.
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Master Thesis
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Marie Bretagne. Déséquilibre de la composition corporelle chez les patients atteints de cancer : conséquences sur l’estimation de la fonction rénale et la toxicité du carboplatine. Médecine humaine et pathologie. 2018. ⟨dumas-01926678⟩

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