Many Breast Ca Patients Have Renal Impairment: Watch for Nephrotoxicity


SAN ANTONIO — Renal insufficiency is extremely common in breast cancer patients—and so is the use of potentially nephrotoxic anticancer drugs, Dr. Vincent Launay-Vacher reported at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

He presented the results of a large multicenter French observational study that sounded a cautionary note regarding the heightened potential for adverse renal effects in patients undergoing cancer treatment.

The French IRMA study included all patients with solid cancers who presented to 15 participating cancer centers during two designated 15-day periods in 2004. Of the 4,684 cancer patients, 1,898 had breast cancer.

Fifty-two percent of the breast cancer patients had renal impairment as defined by a creatinine clearance of less than 90 mL/minute by the Cockroft-Gault formula, as did 51% by the Modification of Diet in Renal Disease (MDRD) Study formula.

Ten percent of the breast cancer patients weren't on any anticancer drugs at the time of the study. Ninety percent of the rest were on at least one anticancer drug requiring a dose adjustment in the setting of renal impairment or for which no data are available regarding use in renally impaired patients. Seventy-seven percent of women received at least one potentially nephrotoxic drug, according to Dr. Launay-Vacher of Saltpetriere Hospital, Paris.

Moreover, 44% of recipients of potentially nephrotoxic drugs had a serum hemoglobin level below 12 g/dL, and 21% had a hemoglobin of less than 11 g/dL. This becomes clinically relevant because anemia magnifies the nephrotoxicity risk, the physician added.

The findings in the overall IRMA study population were similar to those in the subgroup with breast cancer. Overall, 60% of cancer patients had a creatinine clearance of less than 90 mL/minute. Eighty percent of cancer patients were receiving one or more nephrotoxic drugs.

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