Effects of unidentified renal insufficiency on the safety and efficacy of chemotherapy for metastatic colorectal cancer patients: a prospective, observational study

Chen, Jian; Wang, Xiaoting; Luo, Peihua; He, Qiaojun

doi:10.1007/s00520-014-2461-3

Cited by 25 publications

(17 citation statements)

References 18 publications

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“…Recently, two studies showed the importance of anticancer drug dosage adjustments in those patients with a GFR lower than 60. In the first study, Chen et al 14 included 143 patients with metastatic colorectal cancer. All patients had normal serum creatinine (Scr) at inclusion and were all treated the same, at the usual dosage of chemotherapy.…”

Section: Ri In Patients With Cancer: Prevalence and Impact On Survivamentioning

confidence: 99%

Renal insufficiency and cancer treatments

2016

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Renal insufficiency has been shown to be highly prevalent in patients with cancer. This renal insufficiency has been reported to be associated with reduced overall survival and increased cancer-related mortality. Therefore, it is important to screen patients with cancer for renal insufficiency, using an adequate and reliable method of estimation of the renal function. Renal insufficiency may influence 1 or several of the 4 pharmacokinetic phases (absorption, distribution, metabolism, elimination/excretion), potentially resulting in marked modifications of the pharmacokinetic profile of a drug in patients with renal insufficiency. Consequently, it is potentially necessary to adjust the dosage of anticancer drugs in case of renal insufficiency in order to avoid drug accumulation and in order to reduce overdosage-related side effects. This dosage adjustment of anticancer drugs should be performed according to the level of renal function and with an appropriate and validated method. It is not always easy to find clear information on anticancer drug handling in these patients. However, several guidelines, publications and handbooks are available on how to adjust anticancer drug dosages in patients with renal insufficiency and will help practitioners to manage anticancer drugs in such patients.

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Section: Ri In Patients With Cancer: Prevalence and Impact On Survivamentioning

confidence: 99%

Renal insufficiency and cancer treatments

2016

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“…The IRMA-2 study also demonstrated a reduced survival for cancer patients with renal dysfunction (16.4 vs. 25.0 months) and higher rates of dose-related adverse events [20]. Chen et al found that 35% of colorectal cancer patients with normal creatinine values had a GFR less than 60 mL/hr [21], which led to a longer toxicity duration and the development of significantly more Grade 1 and 2 toxicities. In contrast, a study by Lichtman et al of elderly patients with early breast cancer receiving either cyclophosphamide/doxorubicin (AC) or cyclophosphamide/methotrexate/fluorouracil (CMF) found no significant effect on relapse-free or overall survival with lower calculated GFRs [22].…”

Section: Discussionmentioning

confidence: 99%

Dosing Oncology Therapeutics in Combination Therapy for Renal Dysfunction: The University of California San Diego Study of Personalized Cancer Therapy to Determine Response and Toxicity (UCSD-PREDICT) Experience

Nikanjam¹,

Wing²,

Capparelli³

et al. 2018

Cureus

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IntroductionDose reductions are often required to avoid toxicity in combination therapy for advanced cancers, but information on appropriate dose reductions in renal dysfunction is lacking. This study assessed dose reductions of renally cleared oncology agents given in combination therapy in the setting of renal dysfunction.MethodsA database of 1,072 patients was screened to identify patients with renal dysfunction (glomerular filtration rate < 60 mL/min) receiving oncology combination therapy with at least one agent requiring dose reduction for renal insufficiency. The dose of the renal agent was compared to the single-agent renal dosing recommendations to calculate a dose percentage. Tolerability was determined from electronic medical records review.ResultsThirty-three regimens (n = 25 patients) were identified: 11 included at least one targeted agent (n = 8 patients) and 22 had only cytotoxic chemotherapy (n = 18 patients). The renal agent was given at the recommended single-agent renal dose in ~50% of combinations; ~50% of all regimens were tolerated, and only six combinations had dose reductions for toxicity. The median final dose percentage was 100% of the recommended renal dose (range: 25% - 333%); no significant differences were seen between groups (cytotoxic - tolerated, cytotoxic - not tolerated, targeted - tolerated, targeted - not tolerated; p = 0.38). No significant differences were observed between tolerated vs. non-tolerated (p = 0.97) or targeted vs. cytotoxic (p = 0.80) regimens.ConclusionsDose reductions of renally cleared agents are highly variable in oncology patients with renal dysfunction. Additional studies are needed to determine appropriate dosing adjustments in this population.

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“…4,5 The impact of the failure to recognize impaired kidney function has clinical significance. 20 In a study of patients with metastatic colon cancer who received a combination of capecitabine and oxaliplatin, patients were dosed based on their serum creatinine values, which were in the normal range. 20 Patients were stratified based on creatinine clearance, as determined by the Cockcroft-Gault formula (creatinine clearance = [(140 − age in years) * (weight in kg)]/[72 * serum creatinine in mg/dL; multiply by 0.85 for women]).…”

Section: Assessment Of Kidney Function In Patients With Cancermentioning

confidence: 99%

“…20 In a study of patients with metastatic colon cancer who received a combination of capecitabine and oxaliplatin, patients were dosed based on their serum creatinine values, which were in the normal range. 20 Patients were stratified based on creatinine clearance, as determined by the Cockcroft-Gault formula (creatinine clearance = [(140 − age in years) * (weight in kg)]/[72 * serum creatinine in mg/dL; multiply by 0.85 for women]). In doing so, 35% of patients with a creatinine clearance <60 mL/minute (despite normal serum creatinine values) were identified.…”

Section: Assessment Of Kidney Function In Patients With Cancermentioning

confidence: 99%

Onconephrology: The intersections between the kidney and cancer

Rosner

Jhaveri

McMahon

et al. 2020

CA A Cancer J Clinicians

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Onconephrology is a new subspecialty of nephrology that recognizes the important intersections of kidney disease with cancer. This intersection takes many forms and includes drug-induced nephrotoxicity, electrolyte disorders, paraneoplastic glomerulonephritis, and the interactions of chronic kidney disease with cancer. Data clearly demonstrate that, when patients with cancer develop acute or chronic kidney disease, outcomes are inferior, and the promise of curative therapeutic regimens is lessened. This highlights the imperative for collaborative care between oncologists and nephrologists in recognizing and treating kidney disease in patients with cancer. In response to this need, specific training programs in onconephrology as well as dedicated onconephrology clinics have appeared. This comprehensive review covers many of the critical topics in onconephrology, with a focus on acute kidney injury, chronic kidney disease, drug-induced nephrotoxicity, kidney disease in stem cell transplantation, and electrolyte disorders in patients with cancer.

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Effects of unidentified renal insufficiency on the safety and efficacy of chemotherapy for metastatic colorectal cancer patients: a prospective, observational study

Cited by 25 publications

References 18 publications

Renal insufficiency and cancer treatments

Renal insufficiency and cancer treatments

Dosing Oncology Therapeutics in Combination Therapy for Renal Dysfunction: The University of California San Diego Study of Personalized Cancer Therapy to Determine Response and Toxicity (UCSD-PREDICT) Experience

Onconephrology: The intersections between the kidney and cancer

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