Adverse events from novel anticancer targeted agents represent a growing problem for oncologists and nephrologists, who should cooperate to recognize, understand and adequately treat toxic effects
The management of novel targeted anticancer agents in patients with chronic kidney disease or receiving haemodialysis is challenging because of a shortage of specific data
Recognition and prompt and proactive management of kidney toxic effects is necessary to aid in the proper administration of life-prolonging oncological treatments
Nephrologists and oncologists should initially treat renal toxic effects related to targeted anticancer agents according to available guidelines, because oncological patients do not necessarily differ from other patients with nephropathy
A subspeciality of onconephrology urgently needs to develop, as only close cooperation and cultural change will improve the management and outcomes of patients with both cancer and kidney disease
The use of novel targeted anticancer agents has led to overall improvement in the prognosis of many patients affected by various malignancies, but has also been associated with an increased risk of poorly characterized toxic effects to different organs, including the kidneys. The high prevalence of kidney impairment in the general population complicates the issue further. Nephrologists most frequently work with patients with cancer when they are asked to investigate kidney function to assess the need for dose adjustments in anticancer therapy. A thorough knowledge of the renal safety profile of novel life-prolonging anticancer therapies, specific features of their metabolism, and pharmacokinetic and pharmacodynamic properties (under normal circumstances as well as in the setting of renal replacement therapy) is, therefore, necessary to preserve kidney function as far as possible and to ensure optimum treatment. In this Review we summarize the present knowledge of renal toxic effects from novel targeted anticancer agents and discuss whether the management of patients' treatment needs to be modified. We also advocate the development of a new onconephrology subspeciality.
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Renal toxicity of targeted therapies for renal cell carcinoma in patients with normal and impaired kidney function
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This Review is the result of a Joint Italian Association of Medical Oncology (AIOM)/Italian Society of Nephrology (SIN) Working Group on Onco-Nephrology.
The authors declare no competing financial interests.
Supplementary Table 1
Common terminology criteria for reporting of adverse events of treatment-related kidney toxicities.7 (DOCX 21 kb)
Supplementary Table 2
Approved oncological indications for eight classes of cancer-targeted agents (DOCX 20 kb)
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Porta, C., Cosmai, L., Gallieni, M. et al. Renal effects of targeted anticancer therapies. Nat Rev Nephrol 11, 354–370 (2015). https://doi.org/10.1038/nrneph.2015.15
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