Editor’s Pick: Targeted Agents in Patients with Metastatic Renal Cell Carcinoma on Dialysis: Myths and Reality

Targeted therapies (vascular endothelial growth factor/vascualar endothelial growth factor receptor targeting agents and/or mammalian target of rapamycin inhibitors) for the treatment of metastatic renal cell carcinoma have changed the treatment landscape of patients suffering from end-stage renal disease requiring dialysis. Data about the pharmacokinetics of these drugs in renal failure are scarce and the timely paper by Guida et al. that follows provides an informative summary of the available literature on this topic. This paper can be highly recommended to nephrologists and oncologists involved in the difficult management of these patients. Prof Norbert Lameire

Annalisa Guida,1 Laura Cosmai,2,3 Fabio Gelsomino,1 Cristina Masini,4 Roberto Sabbatini,1 *Camillo Porta3,5

1. Oncologia Medica, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
2. Nefrologia e Dialisi, Istituti Ospitalieri, Cremona, Italy
3. Joint Italian Society of Nephrology (SIN)/Italian Association of Medical Oncology (AIOM) working group on Nephro-Oncology
4. Oncologia Medica, I.R.C.C.S. Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy
5. Oncologia Medica, I.R.C.C.S. Fondazione Policlinico San Matteo, Pavia, Italy
*Correspondence to c.porta@smatteo.pv.it

Disclosure: The authors have declared no conflicts of interest.
Received: 04.04.16 Accepted: 09.05.16
Citation: EMJ Nephrol. 2016;4[1]:66-77.

Abstract

Agents targeting the vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) pathway, as well as mammalian target of rapamycin (mTOR) inhibitors have revolutionised the therapeutic landscape of metastatic renal cell carcinoma (mRCC) in the past decade, greatly improving the survival rates of these patients. However, translating results of registrative Phase III trials into everyday clinical practice is often troublesome, since real-world patients are completely different from those enrolled in randomised controlled Phase III trials. Prospective data on active oncological treatments in mRCC patients on dialysis are dramatically lacking. This literature review summarises and critically comments on available data relative to mRCC patients on dialysis receiving either VEGF/VEGFR-targeting agents, or mTOR inhibitors. Although prospective studies would definitely be warranted in these specific patient populations, all the available data suggest that mRCC patients on dialysis have the same outcome, both in terms of efficacy and safety, as mRCC patients with normal or marginally impaired kidney function, when treated with VEGF/VEGFR-targeting agents and/or mTOR inhibitors.

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