Limitations of Systemic Oncological Therapy in Breast Cancer Patients with Chronic Kidney Disease

Abstract

Breast cancer is the most common malignancy, affecting middle-age and older women frequently suffering from other chronic diseases, including chronic kidney disease. The risk of breast cancer development in women on renal replacement therapy (peritoneal dialysis and haemodialysis) is higher than in the general population. Chronic kidney disease does not limit surgical treatment or radiotherapy; however, it affects the pharmacokinetics of drugs used in the systematic treatment to a different extent, increasing their toxicity and the risk of adverse drug reactions. This article summarizes the current knowledge (published studies accessed through PUBMED) on drugs used in chemotherapy, hormone therapy, anti-HER2 drugs, CDK4/6 inhibitors, PARP inhibitors, and immune therapy in breast cancer patients undergoing dialysis. We discuss the data, the optimal choice of the chemotherapeutic protocol, and the administration of drugs in a specific time relation to the haemodialysis session to ensure the most effective and safe treatment to breast cancer patients.

Favorable survival with combined treatment in a metastatic breast cancer patient undergoing hemodialysis: A case report

“…Even drugs that are generally administered at the full dose had to be reduced due to AEs, including thrombosis, FN, hemorrhagic cystitis, and anemia. Although there is no recommended dosage reduction in the literature for T-DM1, T-mab, P-mab, and letrozole [ 8 ], we were able to administer these drugs at the full dose without any major AEs.…”

“…Regarding the treatment of breast cancer patients who are receiving HD, the most important clinical issue is drug selection and dosage adjustment. The recommendations for dosage adjustment for oncological therapy among patients receiving HD are shown in Table 1 [ 8 , 9 ]. Most drugs are safe to administer in patients receiving HD, and methotrexate is the only drug that should be avoided.…”

Nephrological management of renal cell carcinoma (RCC) patients: A narrative review

“…Not all molecules are removed from the blood and, even when this happens, in hemodialysis the purification process is carried out only during the three typical dialysis sessions per week. 79 In this specific group of patients, to ensure the most effective and safe treatment of cancer is mandatory to optimally choose the therapeutic dose and protocol and to know which drugs needs to be administered in specific time relation to the dialysis procedure. It must be remembered that the benefits of systemic therapy should be weighed against an increased risk of toxicity, as well as deterioration of the health-related quality of life.…”

“…It must be remembered that the benefits of systemic therapy should be weighed against an increased risk of toxicity, as well as deterioration of the health-related quality of life. 79 The US Renal Data System indicates an increased risk of cancer, in particular of RCC cancer, among patients on dialysis so they should be periodically screened. 79 As regards CECT, there is no need to coordinate the time of the hemodialysis session with the CM administration or to organize an extra session to remove CM.…”

“…79 The US Renal Data System indicates an increased risk of cancer, in particular of RCC cancer, among patients on dialysis so they should be periodically screened. 79 As regards CECT, there is no need to coordinate the time of the hemodialysis session with the CM administration or to organize an extra session to remove CM. 80,81 Transplanted patients.…”