The CANcer and DialYsis (CANDY) study, which retrospectively evaluated treatment patterns and clinical outcomes in patients undergoing chronic dialysis who subsequently developed cancer, showed that chemotherapy was omitted or prematurely stopped in many cases or was often not adequately prescribed, and survival was poor in this cohort of patients. This study highlights the challenges facing oncologists who are treating patients with cancer on chronic dialysis.
The number of patients developing cancer on dialysis is increasing. There is lack of data on pharmacokinetics of many chemo agents to be used in CKD and ESRD patients. In this study, over 170 patients in multicenter were evaluated from the time from initiation of dialysis to development of cancer. Most common cancers were genitourinary, followed by hematologic and then others. Close to 30% received anti cancer therapy. Among patients who received anticancer therapy, 72% received at least one drug that required a dosage adjustment, and 82% received at least one drug that needed to be administered after dialysis to avoid elimination. The problems encountered were not enough data on how to administer the chemo and when to in dialysis patients for certain agents. Most data comes from case reports and case studies. The authors concluded that for those drugs that are lacking recommendations, it may be advisable to use another appropriate drug for which clear dosage adjustment recommendations are available (whenever possible). Hence, there is a major need for studies to assess the characteristics of many agents in dialysis patients.
Check out the full paper in Annals of Oncology