Lapatinib and renal impairment: a case report
Tumori
|October 26, 2013
Summary
This case report shows long-term control of HER2-positive breast cancer liver metastasis in a postmenopausal patient. The patient received letrozole plus lapatinib after prior treatment failure.
Area of Science:
- Oncology
- Medical Oncology
- Clinical Medicine
Background:
- Metastatic breast cancer (MBC) with HER2-positive and estrogen receptor-positive (ER+) subtypes presents treatment challenges.
- Sequential therapy is often required following progression on initial treatments.
- Hormone therapy and HER2-targeted agents are mainstays of treatment for ER+/HER2+ MBC.
Observation:
- A postmenopausal patient with ER+/HER2+ breast cancer developed liver metastasis.
- The patient had previously failed anastrozole plus trastuzumab therapy.
- The patient was initiated on hemodialysis and treated with letrozole plus lapatinib.
Findings:
- Durable disease control was achieved with the combination of letrozole and lapatinib.
- The treatment regimen was tolerated in the context of hemodialysis.
- This suggests a potential therapeutic option for heavily pretreated patients.
Implications:
- This case highlights the potential efficacy of combining endocrine therapy (letrozole) with a tyrosine kinase inhibitor (lapatinib) in advanced ER+/HER2+ breast cancer.
- It suggests that this combination may be a viable option for patients who have progressed on standard therapies, including those requiring hemodialysis.
- Further investigation into this treatment strategy in similar patient populations is warranted.
Related Concept Videos
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
387
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
387
01:11Renal Failure: Dose Adjustments
675
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
675
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
374
In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
374
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
582
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
582
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
275
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
275
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
358
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
358