Italian scientists studying the popular mesothelioma chemotherapy drug pemetrexed (Alimta) have some sobering news for patients: Kidney damage remains a risk, even in patients whose kidney function tests are on the low end of normal.
Doctors in the nephrology and dialysis unit at St. Andrea Hospital in La Spezia, Italy, performed a retrospective evaluation of 38 patients with non-small cell lung cancer who developed kidney injuries after being treated with pemetrexed. Twenty nine of the study participants had no other risks for renal damage.
The guidelines for administering pemetrexed to patients with mesothelioma, NSCLC, and other types of cancer say that the patient’s eGFR, a measure of kidney function, should be higher than 45. Although all of the patients in the new study had a baseline eGFR over 45, 21% of them still developed acute kidney injury (AKI) after treatment with pemetrexed. Among these patients, those with the lowest eGFR had the highest chance of problems.
“The number of patients with baseline eGFR <60 mL/min/1.73 m2 was higher (4/6) in the group that developed AKI as compared to those who did not,” writes lead author Giuseppe Rombola in the Journal of Nephrology. Dr. Rombola and his colleagues conclude that there is “no clear-cut eGFR above which pemetrexed may be used without potential risks of renal toxicity”.
Although it was performed on lung cancer patients, this new research may also have important implications for people with mesothelioma. A mix of pemetrexed and a platinum drug is usually used, with or without surgery, to treat patients with malignant pleural mesothelioma. The new study suggests that, for mesothelioma patients and others on this treatment, risk factors for AKI should be corrected, if possible, even in cases where the baseline eGFR level meets the recommended guidelines.
Rombola, G, “Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage”, June 23, 2014, Journal of Nephrology, http://link.springer.com/article/10.1007/s40620-014-0117-5#page-2