Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed
Abstract Background Pemetrexed, a multitargeted antifolate cytotoxic agent, is currently used primarily in combination with cisplatin for metastatic non-small cell lung cancer and for malignant mesothelioma. Acute renal toxicity of pemetrexed has been recently described with polychemotherapy, in whi...
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doaj-5f24f9878fca44a99771e7e0dc1878632020-11-24T21:46:01ZengBMCBMC Cancer1471-24072017-11-011711810.1186/s12885-017-3705-7Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexedMaureen Assayag0Philippe Rouvier1Marion Gauthier2Ghania Costel3Philippe Cluzel4Lucile Mercadal5Gilbert Deray6Corinne Isnard Bagnis7Pitié Salpêtrière HospitalPitié Salpêtrière HospitalPitié Salpêtrière HospitalMontargis Dialysis CenterPitié Salpêtrière HospitalPitié Salpêtrière HospitalPitié Salpêtrière HospitalPitié Salpêtrière HospitalAbstract Background Pemetrexed, a multitargeted antifolate cytotoxic agent, is currently used primarily in combination with cisplatin for metastatic non-small cell lung cancer and for malignant mesothelioma. Acute renal toxicity of pemetrexed has been recently described with polychemotherapy, in which the individual responsibility of each drug is difficult to establish. Only one recent report documents renal involvement in long-term exposed patients. Case presentation We report on a case of rapidly progressive nephropathy leading to the cessation of platinum salts and the secondary interruption of pemetrexed and bevacizumab. Acute tubular necrosis shown on the renal biopsy could potentially be due to pemetrexed. Persistent severe renal failure after the resumption of all drugs led to new treatment lines with gemcitabine (while the glomerular filtration rate was below 30 ml/min/1.73m2), then followed by Taxol. Conclusions The optimal strategy with regard to renal complications in cancer patients is not clear. Acute or chronic loss in renal function generally leads to a new treatment line, possibly impairing the overall success of the treatment. The use of chemotherapy in patients with a glomerular filtration rate below 30 ml/min/1.73m2 is usually associated with an increased risk of side effects when not contraindicated by renal elimination of the drug.http://link.springer.com/article/10.1186/s12885-017-3705-7 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Maureen Assayag Philippe Rouvier Marion Gauthier Ghania Costel Philippe Cluzel Lucile Mercadal Gilbert Deray Corinne Isnard Bagnis |
spellingShingle |
Maureen Assayag Philippe Rouvier Marion Gauthier Ghania Costel Philippe Cluzel Lucile Mercadal Gilbert Deray Corinne Isnard Bagnis Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed BMC Cancer |
author_facet |
Maureen Assayag Philippe Rouvier Marion Gauthier Ghania Costel Philippe Cluzel Lucile Mercadal Gilbert Deray Corinne Isnard Bagnis |
author_sort |
Maureen Assayag |
title |
Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
title_short |
Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
title_full |
Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
title_fullStr |
Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
title_full_unstemmed |
Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
title_sort |
renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2017-11-01 |
description |
Abstract Background Pemetrexed, a multitargeted antifolate cytotoxic agent, is currently used primarily in combination with cisplatin for metastatic non-small cell lung cancer and for malignant mesothelioma. Acute renal toxicity of pemetrexed has been recently described with polychemotherapy, in which the individual responsibility of each drug is difficult to establish. Only one recent report documents renal involvement in long-term exposed patients. Case presentation We report on a case of rapidly progressive nephropathy leading to the cessation of platinum salts and the secondary interruption of pemetrexed and bevacizumab. Acute tubular necrosis shown on the renal biopsy could potentially be due to pemetrexed. Persistent severe renal failure after the resumption of all drugs led to new treatment lines with gemcitabine (while the glomerular filtration rate was below 30 ml/min/1.73m2), then followed by Taxol. Conclusions The optimal strategy with regard to renal complications in cancer patients is not clear. Acute or chronic loss in renal function generally leads to a new treatment line, possibly impairing the overall success of the treatment. The use of chemotherapy in patients with a glomerular filtration rate below 30 ml/min/1.73m2 is usually associated with an increased risk of side effects when not contraindicated by renal elimination of the drug. |
url |
http://link.springer.com/article/10.1186/s12885-017-3705-7 |
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