title: [Management of chemotherapy in hemodialysis patients].
abstract: BACKGROUND
  The increased incidence of cancer in dialysis patients has been discussed since the mid-70s. Consequently, oncologists, nephrologists and pharmacists are increasingly facing challenging situations of cytotoxic drug handling in dialysis patients. In dialysis patients, two main issues must be considered. First, renal function of hemodialysis (HD) patients is no longer functional. Therefore, these patients may necessitate drug dosage reduction, namely drug prescription, must be cautiously checked before administration with appropriate dosage adjustment whenever necessary to ensure efficacy while avoiding overdosage and related side effects. Secondly, drug clearance by dialysis must be taken into account for appropriate chemotherapy timing in order to avoid drug removal, which may result in a loss of efficacy.
  
  
  METHODS
  We reviewed the international literature on the pharmacokinetics, efficacy, tolerance and dosage adjustment of anticancer drugs used on hemodialysis cancer patients, using the key words: kidney, renal, dialysis, hemodialysis, end-stage renal disease and the name of each drug.
  
  
  RESULTS
  Only case reports and small series were found. 57.1% of the drugs need dosage adjustment and 64.3% should be administered after the dialysis session.
  
  
  CONCLUSIONS
  Cancer treatment in feasible in dialysis patients. Some drugs require dosage adaptation while others can be given as in patients with normal kidney function. These patients need coordinated care between oncologists, nephrologists and pharmacists to optimize drug delivery and logistics. Frailty scores, like in oncogeriatrics, should be built to optimally adapt cancer treatments in these dialysis patients.
authors: Hôpital la Pitié-Salpêtrière, service ICAR, Paris, France. janus@psl.aphp.fr
authors: Nicolas
authors: N
authors: Janus
authors: Vincent
authors: V
authors: Launay-Vacher
authors: Gilbert
authors: G
authors: Deray
authors: Antoine
authors: A
authors: Thyss
authors: Juliette
authors: J
authors: Thariat
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D019468:Disease Management; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D006435:Renal Dialysis
chemical_list: D000970:Antineoplastic Agents