The nephrotoxic effects of anti-cancer therapies: consensus report of the 34th Acute Disease Quality Initiative workgroup

Abstract

In the past few decades, advances in understanding of cancer biology have led to the development of highly effective conventional chemotherapies, targeted therapies that act on specific pathways that are critical to cancer growth, immune-based therapies, and cellular therapies such as haematopoietic cell transplantation and chimeric antigen receptor T cell therapy. However, the nephrotoxic effects of these therapies continue to pose substantial challenges, with many unanswered questions regarding the prevention, diagnosis and management of this nephrotoxicity. Further, a lack of consensus and precise guidance on kidney function estimation and drug dosing for patients with acute kidney disease or chronic kidney disease and for patients receiving kidney replacement therapy limits access to life-saving therapies and jeopardizes outcomes. In this Consensus Statement, we present guidance on the prevention, diagnosis and management of anticancer therapy nephrotoxicity for adult patients that was developed at the 34th Acute Disease Quality Initiative meeting, which convened an international panel of experts in nephrology, haematology, oncology, nephropathology, critical care, paediatric care and pharmacology. We also define a research agenda focused on preventing and mitigating anticancer therapy toxicity, maximizing early detection of nephrotoxicity and enabling optimal drug dosing in patients with kidney disease, with the goal of advancing cancer care and fulfilling the potential of these ground-breaking treatments.