Abstract
BackgroundPemetrexed (PEM) is a new-generation multitargeted antifolate agent with a demonstrated broad-spectrum activity in several types of human cancers, including non-small cell lung cancer (NSCLC) and mesothelioma. Major side effects include dose-limiting hematologic toxicities. PEM nephrotoxicity is well known; however, its frequency is considered to be low.Case PresentationHere we report two cases of acute kidney injury (AKI) related to PEM administration (500 mg/m2) in patients with NSCLC. The first patient required hemodialysis treatment and was submitted to renal biopsy which showed acute tubular damage and interstitial edema without acute tubular necrosis. No other potential nephrotoxic agents were identified. The second patient developed AKI, not proven by biopsy and did not require renal replacement therapy. Both patients, on regular supplementation with folic acid and vitamin B12, concomitantly developed myelosuppression and even several months after PEM withdrawal, showed only a modest improvement of renal function.ConclusionsPEM is an antifolate antineoplastic agent with a broad-spectrum activity in locally advanced or metastatic NSCLC. It has been shown that PEM allows longer survival. The risk of acute or chronic kidney disease may be one of the prices to be paid for this success.
Highlights
Pemetrexed (PEM) is an antifolate antineoplastic agent which has shown clinical efficacy in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) and mesothelioma
The risk of acute or chronic kidney disease may be one of the prices to be paid for this success
About 80% is completely eliminated unchanged by the renal emunctory, and its use is contraindicated if creatinine clearance is below 45 mL/min
Summary
Pemetrexed (PEM) is a new-generation multitargeted antifolate agent with a demonstrated broad-spectrum activity in several types of human cancers, including non-small cell lung cancer (NSCLC) and mesothelioma. The second patient developed AKI, not proven by biopsy and did not require renal replacement therapy. Both patients, on regular supplementation with folic acid and vitamin B12, concomitantly developed myelosuppression and even several months after PEM withdrawal, showed only a modest improvement of renal function. Conclusions: PEM is an antifolate antineoplastic agent with a broad-spectrum activity in locally advanced or metastatic NSCLC. Implication for health policy/practice/research/medical education: Pemetrexed (PEM) is an antifolate antineoplastic agent with a broad-spectrum activity in locally advanced or metastatic nonsmall cell lung cancer (NSCLC).
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