Abstract
Background: Optimal survival benefit from different lines of anticancer treatment in advanced non-small-cell lung cancer (NSCLC) requires conservation of renal function. We evaluated the development of renal impairment during pemetrexed maintenance.
Patients and methods: In a prospective multi-centre cohort study, we evaluated the incidence of acute/chronic kidney disease (AKD/CKD), its related treatment discontinuation frequency and associated clinical variables with AKD in patients with stage IIIB/IV NSCLC treated with pemetrexed maintenance. We validated findings in an independent cohort.
Results: In total 190 patients received pemetrexed. In the primary cohort 149 patients started induction of whom 44 (30%) continued maintenance. In the independent cohort 41 patients received maintenance. During maintenance, 13 patients (30%) developed AKD, leading to CKD and treatment discontinuation in 8 (62%) in the primary cohort. Higher eGFR (unit 5 mL·min−1/1.73 m2) before maintenance and induction (OR 0.70, 95%CI: 0.54–0.90 and OR 0.78, 95%CI: 0.62–0.98, respectively) and relative decline (per 10%) in eGFR during induction (OR 2.54, 95%CI: 1.36–4.74) were associated with AKD during maintenance. In the independent cohort 20 patients (49%) developed AKD, leading to CKD in 11 (55%) and treatment discontinuation in 6 (30%).
Conclusion: Patients are at risk for renal impairment during pemetrexed maintenance, which may jeopardise further lines of anticancer treatment.
Abstract
There is a significant risk of renal impairment during pemetrexed maintenance, which may jeopardise further treatment
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Visser reports grants from ZonMw, during the conduct of the study;.
Conflict of interest: Dr. Huisbrink has nothing to disclose.
Conflict of interest: Dr. van Toor has nothing to disclose.
Conflict of interest: Dr. van Boxem has nothing to disclose.
Conflict of interest: Dr. van Walree has nothing to disclose.
Conflict of interest: Dr. Stricker reports grants from ZonMw, during the conduct of the study;.
Conflict of interest: Dr. Aerts reports grants from ZonMw, during the conduct of the study; other from Eli Lilly and Company, other from Roche, other from Bristol-Myers Squibb, other from MSD, other from Boehringer Ingelheim, outside the submitted work.
Conflict of interest: Dr. van ‘t Veer has nothing to disclose.
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