Abstract
BackgroundPemetrexed maintenance therapy holds tremendous potential in improving the survival of patients with advanced pulmonary adenocarcinoma. Major side effects include myelosuppression and cutaneous reactions. However, little data are available on pemetrexed nephrotoxicity. Our case describes clinically relevant renal events leading to treatment discontinuation in routine practice.Case presentationWe report a case of a 69-year-old Moroccan man treated for metastatic non-small cell lung cancer. He was not on any other medications and he did not receive any nephrotoxic agents. He was exposed to intravenously administered contrast from thoracoabdominal computed tomography in the week of his last pemetrexed treatment. He developed kidney disease related to pemetrexed. He was submitted to renal biopsy, which showed acute tubular damage and interstitial fibrosis. His kidney function remained impaired, but stable, after discontinuation of pemetrexed therapy. He died 5 months later.ConclusionsMedical oncologists should be aware of renal adverse events for patients with advanced non-small cell lung cancer eligible for pemetrexed maintenance therapy. Suggestions for mitigating the risk for renal toxicities (dehydration, non-steroidal anti-inflammatory drugs and zoledronic acid, radiocontrast agents) during pemetrexed maintenance should be followed to enable early detection and management of this adverse event.
Highlights
Pemetrexed maintenance therapy holds tremendous potential in improving the survival of patients with advanced pulmonary adenocarcinoma
Medical oncologists should be aware of renal adverse events for patients with advanced non-small cell lung cancer eligible for pemetrexed maintenance therapy
We report a case of renal insufficiency as a leading cause of maintenance pemetrexed discontinuation for toxicity to advanced non-small cell lung cancer in routine practice
Summary
Suggestions for mitigating the risk for renal toxicities during pemetrexed maintenance should be followed. Cr Cl must be measured before each cycle of pemetrexed administration. CT scans with contrast should be performed a few days to 1 week after pemetrexed administration. Patients must be appropriately hydrated during treatment. Concomitant medications should be reviewed with the patient and, when possible, medications that could potentially be nephrotoxic should be eliminated. A decision to use maintenance chemotherapy requires a discussion between patient and physician that adequately assesses the benefits of prolonged therapy and the impact in terms of toxicity and quality of life
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