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Systemic anticancer therapy in gynecological cancer patients with renal dysfunction
  1. Y. F. Li*,,
  2. S. Fu,
  3. W. Hu*,
  4. J. H. Liu,
  5. K. W. Finkel§,
  6. D. M. Gershenson* and
  7. J. J. Kavanagh*
  1. *Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;
  2. Department of Gynecologic Oncology, The Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China;
  3. Department of Gynecologic Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;
  4. §Department of Internal Medicine, The Division of Renal Diseases and Hypertension, The University of Texas Medical School, Houston, Texas
  1. Address correspondence and reprint requests to: John J. Kavanagh, MD, Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77230, USA. Email: jkavanag{at}mdanderson.org

Abstract

Chronic kidney disease is a common occurrence in patients with gynecological cancer. Systemic anticancer treatment in such patients is a challenge for clinicians because of altered drug pharmacokinetics. For those drugs that are excreted mainly by the kidneys, decreased renal function may lead to increased systemic exposure and increased toxicity. Dose adjustment based on pharmacokinetic changes is required in this situation to avoid life-threatening toxicity. In this review, we summarize the nephrotoxicity and pharmacokinetic data of agents commonly used in systemic anticancer treatment of gynecological cancers and dose adjustment guidelines in the presence of impaired renal function. We review 17 medications that need dose adjustment (cisplatin, carboplatin, doxorubicin, epirubicin, cyclophosphamide, ifosfamide, topotecan, irinotecan, etoposide, capecitabine, bleomycin, methotrexate, actinomycin D, granulocyte–macrophage colony-stimulating factor, metoclopramide, cimetidine, and diphenhydramine) as well as 27 drugs that do not (paclitaxel, docetaxel, pegylated liposomal doxorubicin, gemcitabine, oxaliplatin, fluorouracil, vincristine, letrozole, anastrozole, tamoxifen, leuprorelin, megestrol, gefitinib, erlotinib, trastuzumab, leucovorin, granulocyte colony–stimulating factor, erythropoietin, ondansetron, granisetron, palonosetron, tropisetron, dolasetron, aprepitant, dexamethasone, lorazepam, and diazepam). We also review the formulae commonly used to estimate creatinine clearance, including Cockcroft–Gault, Chatelut, Jelliffe, Wright, and the Modification of Diet in Renal Disease study formulae

  • cervical cancer
  • chemotherapy
  • chronic kidney disease
  • endometrial cancer
  • estimation of creatinine clearance
  • ovarian cancer
  • renal dysfunction
  • renal failure

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