Modulation of cytotoxicity of cytostatic drugs by hemodialysis in vitro and in vivo.

For most cytotoxic substances there are no established guidelines on how to deal with overdosage. Little is known about the dialysability of cytostatic drugs. To obtain further information, human plasma was incubated with cytostatic drugs and dialysed in vitro, using 'minimodules' with capillaries identical to those in clinical use. Cytotoxicity before and after dialysis was measured in a biological test system using permanent human lymphoblast cultures (LS2). The 20 cytostatic drugs studied were categorized as follows: (1) Dialysability in vitro. Good: methotrexate (MTX), 5-fluorouracil (5-FU/5-FUdR), cytarabine (ARAC), actinomycin D (DACT), mitomycin C (MMC), 4-OH-cyclophosphamide (4-OH-CPM), ifosfamide (IFO), melphalan (L-PAM), dacarbazine (DTIC), cisplatin (DDP). Intermediate: Adriamycin (ADM), 4'-epi-doxorubicin (4'-EA), carmustine (BCNU). Ineffective: daunorubicin (DNR), vincristine (VCR), vinblastine (VBL), vindesine (VDS), etoposide (VP-16), teniposide (VM-26), mitoxantrone (MITOX). These in vitro results cannot be transferred automatically into the in vivo situation because of specific drug distribution and metabolic rates. Considering pharmacokinetic data from the literature, the following recommendations can be made for practical clinical purposes. (2) Detoxification by hemodialysis in vivo. Possibly effective: MTX, 5-FU, MMC, CPM, IFO, L-PAM, BCNU, DTIC. Ineffective: ADM, 4'-EA, DNR, MITOX, DACT, VP-16, VM-26, VCR, VBL, VDS, ARAC, DDP.