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N. Van Walree
Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Presentations: 1
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
169P - Nephrotoxicity of pemetrexed maintenance in patients with advanced NSCLC: Two cohort studies (ID 534)
12:30 - 13:00 | Author(s): N. Van Walree
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 and its clinical significance during pemetrexed maintenance.
In a prospective multi-center cohort study, patients with advanced (stage IIIB/IV) NSCLC treated with first-line (platinum-combined) or second-line pemetrexed were enrolled. After platinum-based induction patients were eligible for pemetrexed maintenance if no disease progression occurred. We evaluated the incidence of acute and chronic kidney disease (AKD/CKD), treatment discontinuation frequency due to renal impairment and associations of clinical variables with AKD during maintenance. Both AKD and CKD were defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines. We validated findings in an independent cohort of advanced NSCLC patients treated with pemetrexed maintenance.
In total 213 patients received pemetrexed. In the primary cohort 165 patients started induction of whom 47 (28%) continued maintenance. During maintenance 16 patients (34%) developed AKD, leading to CKD in 11 (69%) and treatment discontinuation in 9 (56%) in the primary cohort. Lower eGFR (unit 5 mL/min/1.73 m) before start of induction (OR 1.32, 95%CI: (1.06–1.64) and relative decline (per 10%) in eGFR during induction (OR 2.11, 95%CI: 1.22–3.65) were univariably associated with AKD during maintenance. In the independent cohort (n = 48), these similar associations could be demonstrated. In this cohort, 24 patients (50%) developed AKD, leading to CKD in 13 (54%) and treatment discontinuation in 7 (29%).
Patients are at risk for renal impairment during pemetrexed maintenance, which may jeopardize further lines of anticancer treatment. Patients whose renal function is impaired before – or declines during – induction treatment are more vulnerable. Renal protective strategies for patients at increased risk might be beneficial, such as continuation of hydration during pemetrexed maintenance or dosing based on renal function.
Clinical trial identification:
Legal entity responsible for the study:
J. Aerts: Member of Scientific Committee ELCC; Consultant/advisory role with Eli Lilly and Company. All other authors have declared no conflicts of interest.
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