Comparison of cisplatin and carboplatin nephrotoxicity in paediatric patients with malignant extra-cranial germ cell tumours

Abstract

Introduction: Survival rates of children with malignant extra-cranial germ cell tumours (MEGCT) have increased, shifting the focus from survival to reducing long-term effects. Current literature reveals significant gaps in understanding short-term and chronic kidney outcomes, as well as relapse and survival rates when comparing cisplatin and carboplatin chemotherapy for these malignancies. This study aims to compare survival and nephrotoxicity rates between cisplatin- and carboplatin-based regimens in children with MEGCT. Methods: We retrospectively analysed data from 70 patients treated at two paediatric oncology units between 1979 and 2019: 47 received cisplatin, and 23 received carboplatin. We assessed nephrotoxicity rates through estimated glomerular filtration rates (eGFR) and electrolyte evidence of tubulopathies, with Kaplan-Meier survival curves estimating survival. Results: The cisplatin group experienced a greater decline in eGFR and a higher incidence of tubulopathies, with 38% experiencing acute kidney injury (p=0.002) and 19% requiring electrolyte supplementation (p=0.025). Both patients who required kidney replacement therapy received cisplatin. Chronic kidney disease was more prevalent in the cisplatin group (30%) compared to the carboplatin group (13%) at the two-year follow-up (p=0.054). Persistent tubulopathies affected 9% of patients in the cisplatin group, and none in the carboplatin group (p=0.295). Four-year overall survival was 79% in the carboplatin group and 91% in the cisplatin group (p=0.313). Conclusion: The incidence of kidney dysfunction was higher in the cisplatin group. Given the comparable survival outcomes, we advise avoidance of cisplatin when possible in patients of standard risk. However, caution is warranted due to the small sample size, which may limit the generalizability of these findings.