Renal impairment during pemetrexed maintenance in patients with advanced nonsmall cell lung cancer: a cohort study

Optimal survival benefit from different lines of anticancer treatment in advanced nonsmall cell lung cancer (NSCLC) requires conservation of renal function. We evaluated the development of renal impairment during pemetrexed maintenance.In a prospective multicentre cohort study, we evaluated the incidence of acute/chronic kidney disease (AKD/CKD), its related treatment discontinuation frequency and associated clinical variables with AKD in patients with stage IIIB/IV NSCLC treated with pemetrexed maintenance. We validated the findings in an independent cohort.190 patients received pemetrexed. In the primary cohort, 149 patients started induction, of whom 44 patients (30%) continued maintenance. In the independent cohort, 41 patients received maintenance. During maintenance 13 patients (30%) developed AKD, leading to CKD and treatment discontinuation in eight patients (62%) in the primary cohort. Higher estimated glomerular filtration rate (eGFR) (per unit 5 mL·min^-1 per 1.73 m²) before maintenance and induction (OR 0.70, 95% CI 0.54-0.90 and OR 0.78, 95% CI 0.62-0.98, respectively) and relative decline (per 10%) in eGFR during induction (OR 2.54, 95% CI 1.36-4.74) were associated with AKD during maintenance. In the independent cohort, 20 patients (49%) developed AKD, leading to CKD in 11 patients (55%) and treatment discontinuation in six patients (30%).Patients are at risk for renal impairment during pemetrexed maintenance, which may jeopardise further lines of anticancer treatment.