Pharmacokinetic/pharmacodynamic considerations for cancer patients undergoing hemodialysis

ABSTRACT

Introduction: The increased incidence of cancer in hemodialysis patients has been discussed since the mid-70s. Today, physicians regularly encounter situations where they must manage the prescription of anticancer drugs in hemodialysis patients.

Areas covered: Hemodialysis patients are at risk of dose-related toxicities due to pharmacokinetic modifications. Hemodialysis patients are at risk of therapeutic drug removal during their hemodialysis session, which may result in a loss of efficacy. In the advent of novel immunotherapies, particularly tumor vaccines, there is an increased theoretical risk of pharmacodynamic modification. Indeed, pharmacodynamic modifications have already been reported for viral vaccines.

Expert opinion: It is important to consider all of the potential pharmacokinetic/pharmacodynamic modifications before prescribing anticancer drugs in hemodialysis patients. However, pharmacokinetic/pharmacodynamic modification should not be considered a contraindication for anticancer drug use in hemodialysis patients, rather, clinicians should be aware of the need individualize treatment according to available recommendations.

KEYWORDS:

• Hemodialysis
• anticancer drugs
• pharmacodynamic
• pharmacokinetic

Article highlights

• Cancer and chronic kidney disease are connected and especially in hemodialysis.

• More and more physicians are facing the question of anticancer drugs handling in hemodialysis patients.

• Hemodialysis patients are facing two different problems: (1) a risk of overdose because of the kidney failure and (2) a risk of inefficiency because of the removal of the anticancer drugs by the hemodialysis session.

• Most of anticancer drugs need dosage adjustment in hemodialysis patients because of pharmacokinetic modifications.

• Many anticancer drugs need a specific timing of administration according to the hemodialysis session.

This box summarizes key points contained in the article.

Declaration of interest

N. Janus has the following indirect conflicts of interest (grants, institutional support, etc.): Bayer, Daiichi-Sankyo, Gilead, Ipsen, Leo Pharma, Pierre Fabre Oncology, Roche, Teva. N. Janus has the following direct conflicts of interest (Honoraria): Leo Pharma, Pfizer, Roche.

V. Launay-Vacher has the following indirect conflicts of interest (grants, institutional support, etc.): Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Gilead, Helsinn, Hospira, Ipsen, Leo Pharma, Pierre Fabre Oncology, Roche, Teva. V. Launay-Vacher has the following direct conflicts of interest (Honoraria/advisor): Amgen, Leo Pharma, Pierre Fabre Oncology, Merck, Roche, Takeda, Teva.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.