Following a diagnosis of mesothelioma, patients have to decide whether they want to have treatment and, if so, what treatment to have. Their decision will be based on the stage of their mesothelioma, their current health and personal preference.
Chemotherapy is a common mesothelioma treatment and is often combined with radiotherapy and/or surgery. The decision to have chemotherapy is not taken lightly. Currently, there is no cure for mesothelioma and so treatment aims to give patients the best quality of life, for as long as possible. The many potential side effects of chemotherapy are a big factor in a patient’s decision on whether to treat their mesothelioma with chemotherapy or not.
Chemotherapy side effects
Common side effects of chemotherapy are:
- Nausea and vomiting
- Hair loss
- Mouth, tongue and throat problems
- Mood changes
Chemotherapy can cause damage to kidneys
A not so well-known side effect of chemotherapy is the risk of kidney damage. It is the kidney’s job to filter waste and toxins from the blood and remove them from the body as urine. In a chemotherapy patient’s body, the kidneys work to break down and remove the chemotherapy drugs from the blood and the drugs can damage cells in the kidneys, causing them to not work properly.
If the kidneys are damaged, they are unable to remove waste and toxins and so these build up in the body and can cause serious issues. The body may swell and, if the damage is severe, the patient may require dialysis or a kidney transplant.
Predicting kidney damage
If there was a way to predict whether a patient was likely to suffer kidney damage from chemotherapy, doctors could better advise and monitor patients, preventing the damage before it was done.
Researchers in Japan have been investigating whether kidney damage can be predicted.
Is megalin the key?
It is thought that megalin may be the key to predicting kidney damage. Megalin is a receptor protein and is also known as LRP2. It is found on the membrane of certain epithelial cells and helps to regulate the uptake of proteins and lipids. Megalin is found on the membrane of cells in the kidneys.
Researchers looked at 45 patients with pleural mesothelioma or lung cancer. Prior to undergoing chemotherapy treatment, they were given a urine test. The levels of megalin in the urine were measured and it was found that the higher the level of megalin, the more likely a patient was to suffer kidney damage due to chemotherapy.
Knowing the risk can help
Knowing how at risk a patient is to kidney damage, before they have chemotherapy, is extremely useful. It will allow doctors to advise alternative treatments where possible. If chemotherapy is the only possible treatment, knowing a patient is high risk for kidney damage allows doctors to monitor this closely and possibly take steps to minimise the damage.
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Shoji, S, et al, “Correlation of prechemotherapy urinary megalin ectodomain (A-megalin) levels with the development of cisplatin-induced nephrotoxicity: a prospective observational study”, December 2019, BMC Cancer, https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-6398-2