Malyszko Jolanta, Lee Michael W, Capasso Giovambattista, Kulicki Pawel, Matuszkiewicz-Rowinska Joanna, Ronco Pierre, Stevens Paul, Tesarova Petra, Viggiano Davide, Capasso Anna
Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
Department of Oncology, Livestrong Cancer Institutes, Dell Medical School, The University of Texas, Austin, Texas, USA.
Kidney Int. 2020 May;97(5):894-903. doi: 10.1016/j.kint.2019.12.023. Epub 2020 Mar 3.
Assessment of kidney function in oncology patients is a fundamental factor in profiling the survival risk, determining the appropriate dose of chemotherapeutic drugs, and defining a patient eligibility for clinical trials with novel agents. Both overestimation and underestimation of kidney function may affect the treatment efficacy and outcomes. Overestimation may lead to overdosing or inappropriate agent selection and the corresponding toxicity, whereas underestimation may be responsible for underdosing or inappropriate agent exclusion and subsequent treatment failure. This is of utmost importance in patients with cancer. Evaluation of kidney function is not only limited to the estimation of glomerular filtration rate or creatinine clearance. An accurate assessment of kidney function is advisable to reduce variability in decision making and ultimately the therapeutic outcomes of toxicity and clinical benefit. Therefore, additional studies are needed to investigate the validity of currently used formulas estimating kidney function in this population as well as their applicability to traditional chemotherapy, novel targeted therapies, and immunotherapies. Because of rapid discovery and development of new cancer agents, a reliable and comprehensive manner to screen for potential nephrotoxicity is critically important. As kidney function not only is limited to glomerular filtration rate changes but also involves tubular and even vascular dysfunction, urinalysis and kidney imaging studies should also be considered before therapeutic decisions are taken. However, several questions remain regarding these new technologies such as kidney-on-a-chip systems for the assessment of kidney function and injury, particularly in oncology, and it has yet to be implemented in clinical practice.
评估肿瘤患者的肾功能是分析生存风险、确定化疗药物合适剂量以及界定患者是否适合使用新型药物进行临床试验的基本要素。肾功能的高估和低估均可能影响治疗效果和结局。高估可能导致用药过量或药物选择不当以及相应的毒性反应，而低估可能导致用药不足或药物选择不当以及后续治疗失败。这对于癌症患者至关重要。肾功能评估不仅限于估算肾小球滤过率或肌酐清除率。为减少决策变异性以及最终减少毒性和临床获益方面的治疗结局，建议对肾功能进行准确评估。因此，需要开展更多研究来调查目前用于估算该人群肾功能的公式的有效性及其在传统化疗、新型靶向治疗和免疫治疗中的适用性。由于新型癌症药物的快速发现和开发，以可靠且全面的方式筛查潜在肾毒性至关重要。由于肾功能不仅限于肾小球滤过率的变化，还涉及肾小管甚至血管功能障碍，因此在做出治疗决策前也应考虑尿液分析和肾脏影像学检查。然而，关于这些新技术仍存在一些问题，例如用于评估肾功能和损伤的芯片肾系统，尤其是在肿瘤学领域，并且该技术尚未在临床实践中得到应用。
