[Impact of lung cancer treatments on renal function]. / Impact des traitements utilisés en oncologie thoracique sur la fonction rénale.

INTRODUCTION: Renal failure in patients with lung cancer may be multifactorial: related to the patients and their comorbidities, direct tumor compression or the toxicity of cancer treatments and other associated medications. This literature review is intended to describe the state of knowledge regarding the nephrotoxicity of treatments used in thoracic oncology. FINDINGS: The majority of chemotherapy treatments are potentially nephrotoxic. Cisplatin and pemetrexed exhibit mainly renal tubular toxicity, while vascular renal impairment is found with gemcitabine and bevacizumab. Cisplatin results in acute renal failure in 30% of patients. Renal protective strategies (compliance with recommendations, limitation of nephrotoxic treatments, hydration, magnesium supplementation) must be employed systematically. Targeted therapies do not require any adjustment of the dosage in case of moderate or severe renal insufficiency but adapting the doses of biphosphonates to renal function is necessary. CONCLUSION: This review highlights the need for monitoring of renal function in patients with lung cancer during treatment with chemotherapy or biphosphonates.

[Utilisation of immunosuppressants in the prevention of a graft versus host reaction: report by the SFGM-TC]. / Immunosuppresseurs dans la prévention de la réaction du greffon contre l'hôte : rapport de la SFGM-TC.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the fourth annual series of workshops which brought together practitioners from all member centers and took place in September 2013 in Lille. Here we report our recommendations regarding the use of immunosuppressive treatment in the prevention of graft versus host disease: report by the SFGM-TC.

Management of voriconazole hepatotoxicity in a lung transplant patient.

Lung allograft airway colonization by Aspergillus species is common among lung transplant recipients. We report the case of a 46-year-old female lung transplant outpatient diagnosed with persistent pulmonary Aspergillus colonization (>50 colonies of Aspergillus terreus) 3 months after lung transplantation. Oral voriconazole 200 mg twice a day (b.i.d) was initiated shortly after diagnosis. Two days after voriconazole initiation, alkaline phosphatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST) were normal or slightly elevated (79, 37, and 21 UI/L, respectively). Ten days after the first voriconazole administration, these values started to increase. Maximum levels were reached after 20 days for ALP (369 UI/L) and at around 30 days for ALT and AST (223 and 188 UI/L, respectively). Instead of discontinuing antifungal therapy, it was decided to reduce the voriconazole dose to 100 mg b.i.d. This asymptomatic progressive cholestatic hepatitis resolved, and 10 days after dose reduction ALP, ALT, AST were at 136, 53, and 28 UI/L, respectively. Finally, therapeutic drug monitoring revealed adequate voriconazole plasma trough concentrations (0.98 mg/L) 30 days after dose reduction and no more colonies of Aspergillus were observed. Voriconazole-induced hepatotoxicity is a well known dose-dependent adverse drug reaction. This experience confirms the appropriateness of voriconazole dose reduction instead of therapy interruption in dose-dependent moderate liver toxicity. Voriconazole therapeutic drug monitoring before and after dose reduction may help to avoid drug accumulation and inappropriately low drug exposure, respectively.

Measurement of end-expiratory pressure during transtracheal high frequency jet ventilation for laryngoscopy.

An anaesthetic technique using high frequency jet ventilation has been proposed for direct laryngoscopy, but this may expose the patients to the risk of barotrauma. In order to assess this risk, we have measured end-expiratory airway pressure (EEP) through the injector using two three-way solenoid valves mounted in series. At the end of insufflation the first valve was switched off and the apparatus deadspace connected to atmosphere through a large exit port during an adjustable time (decompression time). Then the second valve was switched off and the injection line connected to a transducer, allowing measurement of EEP through the injector. The accuracy of this measurement was tested against airway pressure measured directly in the trachea (Pt) in a lung model. Provided that the decompression time was long enough (70 ms) and the apparatus deadspace was small (6 ml), the difference between EEP and Pt was less than 1 cm H2O for frequencies up to 5 Hz. A clinical evaluation was performed in 64 patients under general anaesthesia before laryngoscopy. EEP correlated with end-expiratory pulmonary volume above apnoeic FRC inferred from abdominal and thoracic displacements. At jet frequencies up to 5 Hz, the correlations between these two variables were satisfactory (r greater than 0.88), suggesting that EEP is a good indicator of pulmonary overdistension.