Biomedical papers - Ahead of Print

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | 10.5507/bp.2018.021

Hemodiafiltration and plasma levels of axitinib in a patient with metastatic renal clear cell carcinoma

Jindrich Kopeckya, Alena Tichab, Hana Janeckovac,d, Bohuslav Melichara,e
a Department of Clinical Oncology and Radiotherapy, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
b Department of Research and Development, University Hospital Hradec Kralove, Czech Republic
c Laboratory for Inherited Metabolic Disorders, Department of Clinical Biochemistry, University Hospital Olomouc, Czech Republic
d Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
e Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Background: The standard treatment for metastatic renal cancer is based on vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTor) inhibitors. Compared to other advanced tumors, the treatment of renal cancer is highly affected by impaired renal function; therefore, patients with severe renal insufficiency, including patients on hemodialysis, are generally excluded from clinical trials.

Case report: In the present manuscript we present the case of a renal cancer patient who underwent bilateral nephrectomy and received two lines of treatment. We hypothesized that axitinib, a tyrosine kinase inhibitor, would have a similar plasma concentration to patients without hemodialysis and that the levels before and after hemodiafiltration will not differ significantly, as observed in other targeted therapies.

Conclusion: The observed axitinib concentrations were at least an order of magnitude lower than expected based on the literature and measurements in other patients. The present case report indicates a potential risk of axitinib underdosing in patients on hemodiafiltration with the standard dose; therefore, drug dosage may need to be corrected based on the plasma levels of axitinib.

Keywords: axitinib, renal cancer, chronic kidney failure, hemodialysis, protein-tyrosine kinases, nephrectomy

Received: December 10, 2017; Accepted: April 13, 2018; Prepublished online: May 15, 2018


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