Doctors should be cautious when prescribing everolimus to patients with impaired kidney function, according to researchers.
In a retrospective study, a team led by Jung Eun Lee, MD, of Samsung Medical Center in Seoul, South Korea, found higher risks of acute kidney injury (AKI) among patients with renal cell carcinoma (RCC) treated with everolimus as an anticancer therapy. Still, everolimus treatment continued in many patients at a reduced dose or after a short off period.
Therefore, treatment decisions should be made using a “multidisciplinary approach that includes the assessment of the oncological benefit of everolimus and other therapeutic options for cancer in each individual,” the researchers wrote in an online report in BMC Cancer.
Dr. Lee’s team investigated the development of AKI in 110 patients at the center who received everolimus at 10 mg daily for more than 4 weeks. Most had advanced RCC.
AKI developed in 23% of RCC patients, with two-thirds of the cases linked to everolimus. The researchers could identify no other kidney insults, such as other nephrotoxic drugs, contrast media, hypotension, infection, urinary tract obstruction, or volume depletion.
Having lower baseline glomerular filtration rate (eGFR) was the only independent risk factor for everolimus-associated AKI. RCC patients had much lower eGFR to start with, compared with patients who had other cancers, none of whom experienced AKI.
The occurrence of AKI did not have a high impact on therapeutic decision-making. Nine of 14 patients with everolimus-associated AKI continued receiving the drug at a reduced dose or after a short period off of the drug. The drug was discontinued in 4 patients because their malignancies had progressed. Only 1 patient stopped everolimus because of AKI.
Potential everolimus nephrotoxicity along with kidney impairment and other factors may contribute to AKI, the researchers suggested. The dosage of everolimus as an anticancer treatment is 10 mg per day, which is about 3 times higher than that used for immunosuppression in kidney transplant recipients.