Ren Song, Wang Wei, Yao Xiaoxiu, Fang Wenyan, Li Guisen, Feng Yunlin, Xia Min
Department of Nephrology and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China.
Department of Health Management, Damian Honghe Community Health Service Center of Longquanyi District, Chengdu, China.
Front Pharmacol. 2025 Mar 13;16:1511171. doi: 10.3389/fphar.2025.1511171. eCollection 2025.
To summarize current evidence on kidney related adverse events (AEs) following targeted therapies in lung cancer from trial settings.
A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Library. Randomized controlled trials that had reported kidney related AEs following targeted therapies in lung cancer were eligible. Outcomes included renal dysfunction as reported, increased serum creatinine, proteinuria, urinary tract infection (UTI), and electrolyte disorders. The risk of bias was assessed using the Cochrane guidelines. The incidence of the examined outcomes, along with their corresponding 95% confidence intervals (CIs), were combined using a random-effects model. Network analysis was applied if the comparisons had passed the consistency test. Publication bias was assessed using Funnel plot analysis.
57 studies encompassing 11,497 patients were included. The pooled incidences (95% CI) of acute kidney injury (AKI), increased serum creatinine, proteinuria, and UTI following targeted therapies in lung cancer were 1% (0%, 2%), 4% (1%, 8%), 9% (6%, 13%), and 6% (2%, 12%), respectively. Targeted therapies did not increase the risk of AKI, yet were associated with higher incidence of proteinuria, particularly vascular endothelial growth factor inhibitors containing therapies. Multiple electrolyte disorders could be observed following targeted treatments, with the pooled incidences ranging from 4% to 21%; however, most electrolytes disorders had limited number of reports. Most of the reported kidney related AEs were of Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or 2. Publication bias was present for kidney related AEs excluding AKI.
Kidney related adverse events are not uncommon following targeted therapies in lung cancer in trial settings. In comparison to chemotherapy alone, targeted therapies did not increase the risk of AKI, yet were associated with higher risk of proteinuria. Proteinuria and electrolytes disorders are more often observed than renal dysfunction and UTI. All types of AEs were mostly mild in severity.
PROSPERO CRD42023441979.
总结试验环境下肺癌靶向治疗后肾脏相关不良事件（AE）的现有证据。
在MEDLINE、EMBASE和Cochrane中央图书馆进行系统检索。纳入报告肺癌靶向治疗后肾脏相关AE的随机对照试验。结局包括报告的肾功能不全、血清肌酐升高、蛋白尿、尿路感染（UTI）和电解质紊乱。使用Cochrane指南评估偏倚风险。采用随机效应模型合并所检查结局的发生率及其相应的95%置信区间（CI）。如果比较通过一致性检验，则应用网络分析。使用漏斗图分析评估发表偏倚。
纳入了57项研究，共11497例患者。肺癌靶向治疗后急性肾损伤（AKI）、血清肌酐升高、蛋白尿和UTI的合并发生率（95%CI）分别为1%（0%，2%）、4%（1%，8%）、9%（6%，13%）和6%（2%，12%）。靶向治疗未增加AKI风险，但与蛋白尿发生率较高相关，尤其是含血管内皮生长因子抑制剂的治疗。靶向治疗后可观察到多种电解质紊乱，合并发生率为4%至21%；然而，大多数电解质紊乱的报告数量有限。大多数报告的肾脏相关AE为不良事件通用术语标准（CTCAE）1级或2级。除AKI外，肾脏相关AE存在发表偏倚。
在试验环境下，肺癌靶向治疗后肾脏相关不良事件并不少见。与单纯化疗相比，靶向治疗未增加AKI风险，但与蛋白尿风险较高相关。蛋白尿和电解质紊乱比肾功能不全和UTI更常被观察到。所有类型的AE大多为轻度。
PROSPERO CRD42023441979。
