Drug management of prostate cancer: prevalence and consequences of renal insufficiency.
BACKGROUND
The Renal Insufficiency and Anticancer Medications (IRMA) study reported a renal insufficiency (RI) prevalence of 50%-60% in a population of almost 5000 patients with solid tumors, 80% of whom were being treated with anticancer drugs that either necessitated dosage adjustment or were potentially nephrotoxic drugs. A national multicenter study from 15 cancer centers in France analyzed IRMA data on patients with prostate cancer.


METHODS
Data on patients with prostate cancer from the IRMA study were analyzed. Renal function was calculated using Cockcroft-Gault and abbreviated Modification of Diet in Renal Disease (aMDRD) formulas to estimate the prevalence of RI. Anticancer drugs' potential renal toxicity and need for dosage adjustment were detailed.


RESULTS
Of the 222 IRMA patients with prostate cancer, 14.9% had a serum creatinine (SCr) level of > 110 micromol/L. When using Cockcroft-Gault and aMDRD formulas, 62.6% and 55.9%, respectively, of the patients had RI. Of the 228 anticancer drug prescriptions, 82.9% required dose adjustments for RI or were drugs with no available data on their administration in patients with RI. Of the patients treated, 86.9% received >or= 1 such drug, but only 29.1% received nephrotoxic drugs.


CONCLUSIONS
The prevalence of RI in patients with prostate cancer was very high in spite of a normal SCr level in most cases. Some anticancer drugs, particularly some bisphosphonates and platinum salts, might be nephrotoxic and/or need dosage adjustment. However, other important drugs in prostate cancer, such as docetaxel, neither require dose reduction nor present with potential nephrotoxicity. Both issues were significantly more important in the patients with bone metastases compared with those with nonmetastatic disease.
Launay-Vacher
Vincent
V
Department of Nephrology Pr. Deray, Hôpital Pitié-Salpêtrière, Paris, France. vincent.launay-vacher@psl.aphp.fr
Ayllon
Jorge
J
Janus
Nicolas
N
Spano
Jean-Philippe
JP
Ray-Coquard
Isabelle
I
Gligorov
Joseph
J
Pourrat
Xavier
X
Morere
Jean-François
JF
Beuzeboc
Philippe
P
Deray
Gilbert
G
Oudard
Stéphane
S
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology
D000970:Antineoplastic Agents