内容紹介
Renal Disorders and Drug Therapy
Summary
In recent years, among patients treated with anticancer chemotherapy, the rate of chronic kidney disease has been increasing. Nephropathy is a major potential adverse event in cancer drug therapy. Anticancer chemotherapy, particularly in patients with comorbid chronic kidney disease, requires sufficient examination of the balance between the potential therapeutic benefit and the risk of decreased renal function. The overwhelming diversity of drugs used to treat cancer involves equally diverse nephropathy pathologies and dose adjustments. There is no established method for assessing renal function during cancer drug therapy. Although serum creatinine levels and eGFR are used to assess renal function in real-world clinical settings, they are generally recognized to be somewhat problematic, and there is currently no established method for assessing renal function before and after cancer drug therapy. When assessing renal function for adjusting anticancer drug doses, the Japanese eGFR is recommended. However, if the patient requires an adjustment of the anticancer drug dose, the renal functional assessment method that have used at the clinical trial have a high likelihood of being safe. In addition, despite the importance of the early diagnosis of acute kidney injury(AKI), currently, we cannot strongly recommend biomarker-based assessment for the early diagnosis of anticancer drug-induced AKI.
要旨
高齢化の進行により,がん薬物療法を受ける患者のなかですでに腎障害を認める患者も近年増加の一途をたどっている。がんに対する薬物療法の重要な有害事象に腎障害があり,特に慢性腎臓病を合併した患者での抗がん化学療法は,腎機能がさらに低下するリスクとのバランスを十分に考慮する必要がある。投与時の腎機能評価は,日本腎臓学会の推算式を用いたeGFRでおおよその腎機能を評価することが勧められるが,投与量を調整する場合には治験時と同じ腎機能評価法や推算式を使用して評価すると安全である。さらに抗がん薬によるAKIの診断は重要だが,有効なバイオマーカーは確立していない。
目次
Summary
In recent years, among patients treated with anticancer chemotherapy, the rate of chronic kidney disease has been increasing. Nephropathy is a major potential adverse event in cancer drug therapy. Anticancer chemotherapy, particularly in patients with comorbid chronic kidney disease, requires sufficient examination of the balance between the potential therapeutic benefit and the risk of decreased renal function. The overwhelming diversity of drugs used to treat cancer involves equally diverse nephropathy pathologies and dose adjustments. There is no established method for assessing renal function during cancer drug therapy. Although serum creatinine levels and eGFR are used to assess renal function in real-world clinical settings, they are generally recognized to be somewhat problematic, and there is currently no established method for assessing renal function before and after cancer drug therapy. When assessing renal function for adjusting anticancer drug doses, the Japanese eGFR is recommended. However, if the patient requires an adjustment of the anticancer drug dose, the renal functional assessment method that have used at the clinical trial have a high likelihood of being safe. In addition, despite the importance of the early diagnosis of acute kidney injury(AKI), currently, we cannot strongly recommend biomarker-based assessment for the early diagnosis of anticancer drug-induced AKI.
要旨
高齢化の進行により,がん薬物療法を受ける患者のなかですでに腎障害を認める患者も近年増加の一途をたどっている。がんに対する薬物療法の重要な有害事象に腎障害があり,特に慢性腎臓病を合併した患者での抗がん化学療法は,腎機能がさらに低下するリスクとのバランスを十分に考慮する必要がある。投与時の腎機能評価は,日本腎臓学会の推算式を用いたeGFRでおおよその腎機能を評価することが勧められるが,投与量を調整する場合には治験時と同じ腎機能評価法や推算式を使用して評価すると安全である。さらに抗がん薬によるAKIの診断は重要だが,有効なバイオマーカーは確立していない。