The following is a summary of “How To Deal With Renal Toxicities From Immune-Based Combination Treatments In Metastatic Renal Cell Carcinoma. A Nephrological Consultation For Oncologists,” published in the January 2024 issue of Oncology by Marcello et al.
The landscape of metastatic renal cell carcinoma (mRCC) treatment is undergoing a transformative shift with the approval of various immune-based combinations (ICI + ICI or ICI + antiangiogenic agents) as first-line therapies, showcasing superior efficacy compared to established standards. Despite these advancements, safety concerns persist, with adverse events (AEs) often leading to drug discontinuations or dose reductions, consequently elevating the risk of diminished efficacy. Consequently, a comprehensive understanding of AEs associated with immune-based combinations and effective prevention and management strategies is imperative to optimize therapeutic outcomes.
Renal AEs, though relatively common, pose diagnostic challenges, compounded by the difficulty in attributing these toxicities to specific drugs. Chronic kidney disease (CKD) is prevalent in RCC patients, either pre-existing or as a consequence of cancer and its treatment. Notably, advanced CKD, particularly in dialysis patients, can impact the pharmacokinetics and pharmacodynamics of anticancer agents. Additionally, addressing cancer therapy in kidney transplant recipients presents unique challenges.
This review delves into the nuanced management of immune-based combinations in patients with CKD, those on dialysis, or kidney transplant recipients, exploring their renal toxicities. Emphasis is placed on preventive measures, early detection, and practical management strategies, recognizing the pivotal role of the consulting nephrologist in the multidisciplinary care of these patients. By addressing the intricacies of renal toxicities associated with immune-based therapies, this review aims to provide valuable insights into optimizing treatment outcomes in individuals with mRCC and concurrent kidney-related complexities.
Source: sciencedirect.com/science/article/abs/pii/S0305737224000100
