Risk of Kidney Failure in Patients with Non-Small Cell Lung Cancer (NSCLC) Treated with Pemetrexed

ABSTRACT Background Pemetrexed is effective as both first and later lines of chemotherapy for non-squamous NSCLC. In first-line pemetrexed is used in combination with cis- or carboplatin. In progressive or relapsing disease after platinum based combination chemotherapy it is used as a single-drug. Drug elimination is mainly renal. A few case-reports have described acute renal failure during treatment with pemetrexed. Aim To determine the incidence rate of acute renal failure in patients treated with either single agent pemetrexed or combination therapy, evaluate reversibility of possible renal failure and to identify possible risk-factors for developing acute renal failure. Material and methods A total of 54 consecutive patients receiving single agent pemetrexed and 55 consecutive patients receiving combination platin and pemetrexed were included. Patients were treated between 2008 and 2011. 9 patients did not receive treatment and were excluded. Pretreatment and all subsequent creatinine levels were registered. Acute renal failure was defined according to the RIFLE-criteria as a more than 50 % rise in pretreatment creatinine level within 30 days of latest pemetrexed infusion. Results Fourteen percent in the single agent group and 8 % in the combination chemotherapy group developed acute renal failure (non significant, Chi-Squared-Test). Of these 11 patients, 3 (27 %) regained pretreatment values of creatinine. In the remaining 8 cases, 5 (63 %) had persistent or progressive renal failure (2 in the combination group and 3 in the single agent group). Three patients died shortly after established renal failure (2 in the single agent group and 1 in the combination group). No patients were treated with dialysis. Age, sex, disease stage, performance status, pretreatment creatinine values, number of treatment cycles and co-morbidity were unrelated to development of kidney failure. Conclusion Out of 100 patients treated with pemetrexed, 11 % developed acute renal failure. In the majority of cases, kidney failure was irreversible. We were unable to identify pretreatment factors predictive of kidney injury. Further studies are warranted to address causality between pemetrexed treatment and acute renal failure. Disclosure All authors have declared no conflicts of interest.