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Review Question - QID 108157

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QID 108157 (Type "108157" in App Search)
A 65-year-old male presents to the physician after noticing gross blood with urination. He reports that this is not associated with pain. The patient smokes 1.5 packs per day for 45 years. Dipstick analysis is positive for blood, with 5 RBC per high-power field (HPF) on urinalysis. A cystoscopy is performed, which is significant for a lesion suspicious for malignancy. A biopsy was obtained, which is suggestive of muscle-invasive transitional cell carcinoma. Before radical cystectomy is performed, the patient is started on cisplatin-based chemotherapy. Which of the following is most likely associated with this chemotherapeutic drug?

Gentamicin enhances toxicity risk

31%

76/242

Cardiotoxicity

7%

17/242

Hemorrhagic cystitis

23%

55/242

Myelosuppression

33%

79/242

Addition of mesna decreases drug toxicity

5%

11/242

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Based on the information provided in the vignette, the patient has transitional cell carcinoma of the bladder. He is started on cisplatin-based chemotherapy. Cisplatin is associated with nephrotoxicity, ototoxicity, and peripheral neuropathy. Adverse effects of gentamicin, an aminoglycoside, include nephrotoxicity and otoxicity. One would expect an enhanced toxicity risk when taken together.

Platinum analogs include cisplatin and carboplatin. Cisplatin-based chemotherapy can be used in a variety of cancers, such as testicular, bladder, and ovarian cancers. Cisplatin is believed to cross-link DNA in order to inhibit DNA synthesis. This medication is mostly excreted by the kidneys, and can cause peripheral neuritis, acoustic nerve damage, and damage the kidneys. Recall that aminoglycosides are associated with nephrotoxicity, otoxociticty, neuromuscular blockade, and has teratogenic properties. Due to their overlapping toxicity, this could explain the potentiated risk of nephrotoxicity and otoxicity a patient may have if taking by both drugs.

Incorrect Answers:
Answer 2: Cardiotoxicity is more associated with Doxorubicin and Trastuzumab.
Answer 3: Hemorrhagic cystitis is associated with Cyclophosphamide.
Answer 4: 6-mercaptopurine, 5-fluorouracil, and methotrexate is more associated with myelosuppresion.
Answer 5: Addition of mesna is used to reduce the risk of hemorrhagic cystitis secondary to Cyclophosphamide treatment. Amifostine is a free radical scavenger used to decrease the risk of nephrotoxicity from cisplatin and carboplatin.

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