title: Systemic anticancer therapy in gynecological cancer patients with renal dysfunction.
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.
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230, USA.
authors.forename: Y F
authors.initials: YF
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Fu
authors.forename: W
authors.initials: W
authors.lastname: Hu
authors.forename: J H
authors.initials: JH
authors.lastname: Liu
authors.forename: K W
authors.initials: KW
authors.lastname: Finkel
authors.forename: D M
authors.initials: DM
authors.lastname: Gershenson
authors.forename: J J
authors.initials: JJ
authors.lastname: Kavanagh
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism*
chemical_list: D000970:Antineoplastic Agents