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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 113
 

Renal impairment in prostate cancer: A close look is important


Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication3-Feb-2016

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175561

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How to cite this article:
Naronha V, Pinninti R, Joshi A, Prabhash K. Renal impairment in prostate cancer: A close look is important. Indian J Cancer 2015;52:113

How to cite this URL:
Naronha V, Pinninti R, Joshi A, Prabhash K. Renal impairment in prostate cancer: A close look is important. Indian J Cancer [serial online] 2015 [cited 2019 Aug 19];52:113. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/113/175561


Sir,

We present a case report demonstrating the safety and efficacy of cabazitaxel in the setting of severe renal dysfunction. A 72-year-old gentlemen; nonsmoker, hypertensive of 20-year duration; diagnosed with metastatic castrate resistant prostate cancer. He previously underwent bilateral orchiectomy and had received bicalutamide, palliative radiotherapy, and bisphosphonates for painful skeletal metastases. He received three doses of docetaxel, but had a rise in prostate-specific antigen (PSA) and increase in bone pains. He was clinically stable off chemotherapy, on analgesia; but a year later, his PSA started rising, his bone pains increased, and his creatinine started to rise from 1.2 mg/dl gradually over 1 year to 2.5 mg/dl (creatinine clearance (CRCL) - 25 ml) [Table 1].
Table 1: Pattern of renal parameters and PSA progression

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Workup for the etiology of renal dysfunction was negative, specifically ultrasonography showed no obstructive uropathy. His renal dysfunction was attributed to medications: Zoledronic acid was stopped and his antihypertensive regimen was modified: Amlodipine was substituted for lisinopril and hydrochlorthiazide.

Patient had castrate resistant prostate cancer (CRPC), had failed docetaxel and had severe bone pains and a rising PSA. Cabazitaxel is indicated in such patients, and renal clearance of cabazitaxel is minimal, with no recommended dose adjustment for mild renal impairment (CLCR: 50–80 ml/min), but data are limited for patients with moderate renal impairment (CLCR: 30–50 ml/min), and no data are available for patients with severe renal impairment (CLCR <30 ml/min) or end-stage renal disease.[1]

After a detailed discussion with the patient regarding the possible risks, cabazitaxel was started at an empiric reduced dose of 15 mg/m 2 ( 60% of standard recommended dose) every 3 weeks along with prednisolone. He had no grade 3 or 4 toxicities, and had a gradual improvement in bone pains and a decrease in PSA. His analgesic usage decreased and concurrently, his renal function also improved. So far, he has received six cycles of cabazitaxel at 15 mg/m 2, his PSA has decreased from 6 to 0.87 ng/ml [Table 2], his bone pains are over 50% decreased, and his analgesic usage has decreased. In retrospect, we discovered that he was taking a significant number of non-prescription nonsteroidal anti-inflammatory drugs (NSAIDs), which was probably responsible for renal dysfunction; as his bone pains improved with chemotherapy, his NSAID requirement decreased and his renal parameters improved. This case report highlights the utility and safety of reduced dose cabazitaxel in patients with impaired renal function.
Table 2: Pattern of renal parameters and PSA progression while cabazitaxel therapy

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Despite having a higher incidence of cancer with increasing age, there are only minority of elderly patients with compromised organ function that are enrolled onto clinical trials.[2] Elderly patients with cancer are at particular risk of chemotherapy-induced toxicities as the physiological decline in hepatic and renal function hinders the metabolism and excretion of chemotherapeutic agents.[3],[4] It is essential to review and modify the polypharmacy in the elderly with compromised organ function.

 
  References Top

1.
de Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels JP, Kocak I, et al. TROPIC Investigators. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: A randomised open-label trial. Lancet 2010;376:1147-54.  Back to cited text no. 1
    
2.
Yee KW, Pater JL, Pho L, Zee B, Siu LL. Enrollment of older patients in cancer treatment trials in Canada: Why is age a barrier? J Clin Oncol 2003;21:1618-23.  Back to cited text no. 2
    
3.
Balducci L, Extermann M. Cancer chemotherapy in the older patient: What the medical oncologist needs to know. Cancer 1997;80:1317-22.  Back to cited text no. 3
    
4.
Skirvin JA, Lichtman SM. Pharmacokinetic considerations of oral chemotherapy in elderly patients with cancer. Drugs Aging 2002;19:25-42.  Back to cited text no. 4
    



 
 
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