A 19-year-old man being treated with chemotherapy for testicular cancer presents to hospital
with tinnitis and high-frequency hearing loss. His creatinine is 1.8 mg/dL. Diuresis with 0.9% NaCl
is initiated. Administration of which of the following agents may have prevented these findings?
- A) Mesna
- B) N-acetylcysteine
- C) Leucovorin
- D) Dexrazoxane
- E) Amifostine
0 voters
EXP:
This man is being treated with cisplatin, a platinum-based compound that is one of the first-line
chemotherapeutic agents used for testicular cancer.1
It is well-known to damage the cochlear stereocilia, thereby causing ototoxicity.2 It is also
associated with nephrotoxicity.
3
In an aqueous environment, the chloride ligands of cisplatin are replaced by water molecules. This
generates a positively charged electrophilic moiety that damages DNA.4, 5, 6
Hydration is essential for all patients to prevent cisplatin‐induced nephrotoxicity: 7
• “Specifically, short‐duration, low‐volume, outpatient hydration with magnesium
supplementation and mannitol forced diuresis (in select patients) represent best practice
principles for the safe use of cisplatin.”8
Amifostine is a cytoprotective adjuvant that decreases incidence of cisplatin-induced toxicity if
administered prior to and during cisplatin infusion.9, 10
Mesna decreases the risk of hemorrhagic cystitis in patients being treated with cyclophosphamide.11
N-acetylcysteine decreases the incidence of severe hepatotoxicity caused by acetaminophen
overdose. It regenerates reduced glutathione.12
Leucovorin “rescue” (folinic acid) may be used to mitigate myelosuppression, gastrointestinal
toxicity, neurotoxicity, and acute kidney injury in patients receiving methotrexate.13, 14, 15
Dexrazoxane is a free-radical chelator that decreases the risk of dilated cardiomyopathy in patients
receiving doxorubicin