Targeted and immune therapies among patients with metastatic renal carcinoma undergoing hemodialysis: A systemic review

Systemic treatment of hepatocellular carcinoma: An EASL position paper

“…While a phase I study of sorafenib in patients with hepatic or renal dysfunction did not help in drawing specific conclusions for patients with HCC [74], a large European and Latin American retrospective real-world study reported sorafenib efficacy and safety data similar to those in patients without haemodialysis [75]. Furthermore, based on data on renal cell cancer, it seems that sorafenib, nivolumab, and bevacizumab can be safely used in patients undergoing haemodialysis [76]. Importantly, while waiting for dedicated clinical trials, careful monitoring is recommended in these special populations [65].…”

Systemic treatment of HCC in special populations

“…However, a recently published review on targeted and immune therapies for patients with metastatic renal carcinoma undergoing haemodialysis, including 55 patients treated with sorafenib, 18 patients treated with nivolumab, and 6 patients treated with bevacizumab, concluded that haemodialysis did not seem to modify the expected efficacy and safety of these drugs. 122 Therefore, it seems that these agents can be safely used in patients undergoing haemodialysis, although careful monitoring is recommended in this special population because of frailty and comorbidities associated with CKD.…”

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

“…As a reference, the incidence of AEs in patients receiving hemodialysis treated with molecular targeted therapies and that of irAEs in non-hemodialysis patients treated with ICI are shown. Although limited information is available, the incidence rates of grade 3 or higher AEs in these patients treated with molecular targeted therapies were 26.8% for sunitinib, 23.5% for everolimus, 23.5% for temsirolimus, and 15.4% for axitinib [49]. The incidence rate of irAEs in non-hemodialysis patients was such that in the study of nivolumab monotherapy for patients with renal cell carcinoma mentioned previously, 79% of patients had treatmentrelated AEs, while 19% had grade 3 or higher serious AEs [50].…”

“…According to the calculations based on the 24 case reports and 67 patients detected by SR (26 patients with renal cell carcinoma, 9 with melanoma, 8 with lung cancer, 7 with genitourinary cancer, 4 with urothelial carcinoma, and 13 with other cancers), the response rate to ICIs was 46.2% for patients with renal cell carcinoma, which was the most frequently reported type of cancer in hemodialysis patients. For comparison, information accrued through case reports on patients undergoing hemodialysis treated with various molecular targeted therapies, used as first-line treatment of renal cell carcinoma, indicated the response rates to be 33.3% for sunitinib, 4.4% for mammalian target of rapamycin (mTOR) inhibitors, and 15.4% for axitinib [49]. Despite weak certainty because the comparison was based on case report accumulation, the response rate to ICI in patients undergoing hemodialysis was higher than that in those undergoing molecular targeted therapy.…”