Which CRC Regimens Are More Likely to Harm Kidneys?
Among the various chemotherapy options for metastatic colorectal cancer (CRC), FOLFIRI + bevacizumab is the most likely to cause acute kidney injury (AKI). Prognostic factors for AKI include old age, low body mass index (BMI), proteinuria at baseline, as well as regimens containing bevacizumab, most notably, FOLFIRI + bevacizumab.

The findings can help steer patients at risk for renal injury away from the regimens most likely to cause it. The results also build a case for greater renal monitoring of at-risk patients.

The team reviewed data on 472 patients with metastatic CRC who had received standard triplet regimens — FOLFOX or FOLFIRI plus either bevacizumab or cetuximab. The median age of the patients was 62 years. Renal function — assessed using estimated glomerular filtration rate (eGFR) — was checked every 3 months for 12 months.

For all four regimens, patients' median eGFR fell from 90.9 mL/min/1.73 m2 at baseline to 80.1 mL/min/1.73 m2 at 12 months. Median 12-month eGFR among the 97 patients receiving FOLFIRI + bevacizumab fell the most — to 74.9 mL/min/1.73 m2. The overall incidence of AKI was 9.1% at 12 months. AKI incidence was lowest among the 57 patients treated with FOLFOX + cetuximab, at 2.1%. It was highest among the group that received FOLFIRI + bevacizumab, at 19.2%.

Being older than 64 years, having BMI below 18.5 kg/m2, and baseline proteinuria were independently associated with lower eGFR. Concomitant medications, comorbidities, and other chemotherapy regimens did not significantly influence AKI development.

Source: https://www.medscape.com/viewarticle/974095?src=rss