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Renal dysfunction during osimertinib treatment in patients with non-small cell lung cancer positive for EGFR
Yui Miyazaki1, Eiji Iwama1, Hiroaki Ogata1
1Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Background:
Osimertinib is a standard treatment for non-small cell lung cancer (NSCLC) positive for EGFR activating mutations. Although renal dysfunction associated with osimertinib treatment is reported to be rare, detailed information on this adverse effect is needed because cytotoxic drugs such as pemetrexed are also widely administered for NSCLC but cannot be used in individuals with renal dysfunction.
Methods:
We retrospectively collected clinical data including the serum creatinine concentration and estimated glomerular filtration rate (eGFR) during osimertinib treatment for 130 NSCLC patients.
Results:
Serum creatinine and eGFR worsened gradually during osimertinib treatment, with the median value of creatinine at the point of greatest deterioration differing significantly from that at baseline (0.93 versus 0.72 mg/dL, P < 0.01). Seventy patients (54 %) experienced worsening of the CTCAE grade for creatinine increased, with the frequency of patients with grade 1 or 2 being increased significantly (P < 0.01) at the point of greatest deterioration relative to baseline (grade 1, 46.9 % versus 14.6 %; grade 2, 14.6 % versus 0.8 %, respectively). A higher serum creatinine level at baseline was a significant risk factor for worsening of the CTCAE grade (odds ratio of 1.66, P < 0.001). The median serum creatinine and eGFR at 4 weeks after osimertinib discontinuation had improved to levels similar to those for baseline.
Conclusions:
Renal dysfunction occurred frequently during osimertinib treatment but was ameliorated after drug discontinuation, suggesting that, although renal function should be carefully monitored, its impairment is not likely to affect subsequent chemotherapy in most patients.
Insights
Osimertinib treatment for EGFR-mutated non-small cell lung cancer (NSCLC) can cause frequent, yet reversible, renal dysfunction. Careful monitoring of kidney function is recommended during treatment.
Area of Science:
- Oncology
- Pharmacology
- Nephrology
Background:
- Osimertinib is a standard treatment for EGFR-mutated non-small cell lung cancer (NSCLC).
- Renal dysfunction is a potential adverse effect of osimertinib, necessitating further investigation due to its impact on other NSCLC treatments like pemetrexed.
Purpose of the Study:
- To investigate the incidence and characteristics of renal dysfunction during osimertinib treatment in NSCLC patients.
- To assess the reversibility of osimertinib-induced renal impairment.
Main Methods:
- Retrospective collection of clinical data from 130 NSCLC patients treated with osimertinib.
- Analysis of serum creatinine and estimated glomerular filtration rate (eGFR) during treatment and after discontinuation.
Main Results:
- Serum creatinine and eGFR levels worsened during osimertinib treatment in 54% of patients.
- A higher baseline serum creatinine was a significant risk factor for worsening renal function.
- Renal function improved to baseline levels within 4 weeks of discontinuing osimertinib.
Conclusions:
- Renal dysfunction is a frequent adverse effect of osimertinib in NSCLC patients.
- Osimertinib-induced renal impairment is generally reversible upon drug discontinuation.
- Careful renal function monitoring is advised, but impairment is unlikely to preclude subsequent chemotherapy.
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