Kidney Week

Abstract: PUB325

Safety of Systemic Anticancer Treatment (ST) in Patients with ESKD and Metastatic Renal Cell Carcinoma (mRCC): A Single Institution Experience

Session Information

• Publication Only

Category: Onconephrology

• 1700 Onconephrology

Authors

• Milanez, Tomaz, Onkoloski Institut Ljubljana, Ljubljana, Ljubljana, Slovenia

Tomaz Milanez,

• Arnol, Miha, Univerzitetni klinicni center Ljubljana, Ljubljana, Ljubljana, Slovenia

Miha Arnol,

• Ocvirk, Janja, Onkoloski Institut Ljubljana, Ljubljana, Ljubljana, Slovenia

Janja Ocvirk,

• Seruga, Bostjan, Onkoloski Institut Ljubljana, Ljubljana, Ljubljana, Slovenia

Bostjan Seruga,

• Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States

Edgar A. Jaimes,

Background

ST for mRCC is linked to a variety of adverse events (AEs) including bleeding and infections . A significant number of patients with mRCC develop CKD that can progress to ESKD requiring renal replacement therapy. It is not known however whether these patients have an increased risk for bleeding and infections while receiving ST.

Methods

We identified 29 ESKD patients (21 male, 8 female) with mRCC who received ST that included VEFGR/TK inhibitors, immune check point inhibitors (ICI) or mTOR inhibitors alone or in combination at the Institute of Oncology Ljubljana in Slovenia between December 2009 and January 2023. By manual chart review, we determined the frequency and severity of bleeding and infectious AEs in this cohort while on active treatment for mRCC.

Results

The median age for the patients studied was 71 years (range 47-83). At the start of ST, 20 patients were already on chronic hemodialysis (HD). Six patients had eGFR ≤30 ml/min/1.73m² and three had a GFR >30 ml/min/1.73m² at the start of ST but all patients eventually developed ESKD and were started on chronic HD. Before ST, eight patients experienced a bleeding episode including three who had a gastrointestinal bleed (GIB). Grade 4 epistaxis was seen in three patients, including a patient that developed hemorrhagic shock during first-line treatment with sunitinib. Two patients experienced grade 4 anal hemorrhage, one due to hemorrhoids during first-line therapy with sunitinib. One patient underwent an urgent nephrectomy due to bleeding during treatment with sunitinib and a second patient during pazopanib treatment. In four patients, grade 4 GIB was observed during or after the ST. The cumulative incidence of grade 3/4 bleeding was 0.59 (17 events/29 pts), and 1.4 (40 events/29 pts) for all-grade bleeding. During ST, 10 patients experienced grade 4 infectious AEs. Six developed sepsis, and one, who was in the first cycle of first-line treatment with sunitinib and receiving HD, developed septic shock .

Conclusion

Serious AEs during ST, including bleedings and infections, may be more frequent in mRCC patients with ESKD as compared to the general mRCC population. Clinicians should be aware of this increased risk that may have a significant impact on the duration and selection of ST for these patients.

Funding

• NIDDK Support