a Service ICAR, Pitié-Salpêtrière Hospital , Paris , France.
b Nephrology Department , Pitié-Salpêtrière Hospital , Paris , France.
Expert Opin Drug Metab Toxicol. 2017 Jun;13(6):617-623. doi: 10.1080/17425255.2017.1292252. Epub 2017 Feb 17.
The increased incidence of cancer in hemodialysis patients has been discussed since the mid-70s. Today, physicians regularly encounter situations where they must manage the prescription of anticancer drugs in hemodialysis patients. Areas covered: Hemodialysis patients are at risk of dose-related toxicities due to pharmacokinetic modifications. Hemodialysis patients are at risk of therapeutic drug removal during their hemodialysis session, which may result in a loss of efficacy. In the advent of novel immunotherapies, particularly tumor vaccines, there is an increased theoretical risk of pharmacodynamic modification. Indeed, pharmacodynamic modifications have already been reported for viral vaccines. Expert opinion: It is important to consider all of the potential pharmacokinetic/pharmacodynamic modifications before prescribing anticancer drugs in hemodialysis patients. However, pharmacokinetic/pharmacodynamic modification should not be considered a contraindication for anticancer drug use in hemodialysis patients, rather, clinicians should be aware of the need individualize treatment according to available recommendations.
自 20 世纪 70 年代中期以来，人们就一直在讨论血液透析患者癌症发病率增加的问题。如今，医生经常会遇到需要管理血液透析患者开抗癌药物的情况。涵盖领域：由于药代动力学改变，血液透析患者有发生剂量相关毒性的风险。在血液透析过程中，血液透析患者有治疗性药物清除的风险，这可能导致疗效丧失。在新型免疫疗法，特别是肿瘤疫苗出现的情况下，药效学改变的理论风险增加。实际上，已经有报道称病毒疫苗会引起药效学改变。专家意见：在为血液透析患者开抗癌药物之前，有必要考虑所有潜在的药代动力学/药效学改变。然而，药代动力学/药效学改变不应被视为在血液透析患者中使用抗癌药物的禁忌症，相反，临床医生应根据现有建议注意个体化治疗的必要性。
