Friday, November 22, 2013

Crizotinib and the Kidney

Does crizotinib cause AKI? and is it reversible?

Crizotinib is a ROS-1 inhibitor and acts on anaplastic lymphoma kinase (ALK) to treat non small cell lung cancer.It also inhibits the hepatocyte growth factor tyrosine kinase. Hence, another angiogenesis inhibitor.
In 2011, it was approved for use in NSCLC with abnormal ALK gene mutation. There was some initial concern regarding this agent and renal function. A biopsy proven case of ATN was published not too long ago from France.

A recent analysis from Univ of Colorado looked at 38 patients with NSCLC who got this agent. The mean GFR decreased by 23.9% compared to baseline and most happened in the first 2 weeks of therapy. Pre renal causes were excluded. 84% of the patients recovered renal function back to baseline after cessation of therapy. The investigators thought that the rapid reversibility raised the possibility that this was a tubular creatinine secretion effect rather than nephrotoxic effect. They didn't have biopsy data.

Here is a commentary on this study.

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