Abstract
Few data are available about sorafenib use in patients with metastatic renal cell
carcinoma (mRCC) undergoing hemodialysis. No systematic review has been previously
performed about this issue. The objective of the present review is to investigate
pharmacokinetics and clinical outcomes of sorafenib in mRCC patients undergoing hemodialysis.
According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines, all the literature about mRCC dialysis patients receiving sorafenib, published
from January 1946 to August 2015, was evaluated. Applying inclusion/exclusion criteria,
11 articles were selected for the analysis; 1 patient from our department was also
included. The investigated outcomes were pharmacokinetics, toxicity, response rate,
progression-free survival, and overall survival where available. A total of 36 patients
were included. Median treatment duration was 6.0 months on overall population; median
progression-free survival was 6.3 months (calculated on 19 patients); response rate
was 22% (on 29 patients); median overall survival was 14.9 months (on 28 patients).
Of note, 24 patients started sorafenib at reduced dose; 6 of 36 patients (17%) required
dose reduction due to adverse events (AEs). Sorafenib treatment was discontinued in
7 patients (19%) because of AEs. Most of AEs were Grade 1-2; severe toxicities (Grade
4-5) included G4 anemia (1 case), G4 hypertension (1 case), G4 cerebellar hemorrhage
(1 patient), and a case of G5 subarachnoid hemorrhage. This review confirmed the efficacy
of sorafenib treatment in mRCC patients receiving hemodialysis. Nevertheless, drug
toxicity seems to be increased in these patients, despite the initiation of therapy
at reduced doses; therefore, sorafenib should be used with caution in dialysis patients.
Keywords
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Article info
Publication history
Published online: January 27, 2016
Accepted:
January 19,
2016
Received:
September 30,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
