Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment

Asher A Chanan Khan, Jesús F. San Miguel, Sundar Jagannath, Heinz Ludwig, Meletios A. Dimopoulos

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Renal impairment is a major complication of multiple myeloma. Patients presenting with severe renal impairment represent a greater therapeutic challenge and generally have poorer outcome. However, once patients with renal impairment achieve remission, their outcomes are comparable with those of patients without renal impairment. Therapies that offer substantial activity in this setting are needed. Bortezomib, thalidomide, and lenalidomide have substantially improved the survival of patients with multiple myeloma. Here we review the pharmacokinetics, activity, and safety of these agents in patients with renal impairment. Bortezomib can be administered at the full approved dose and schedule in renally impaired patients; similarly, no dose reductions are required with thalidomide. The pharmacokinetics of lenalidomide is affected by its renal route of excretion, and dose adjustments are recommended for moderate/severe impairment. Substantial evidence has emerged showing that these novel agents improve outcomes of patients with renal impairment, including impairment reversal. Bortezomib, thalidomide, and lenalidomide (at the recommended doses) are active options for patients with mild to moderate impairment, although limited data are available for thalidomide. Information on lenalidomide-based combinations is still emerging, but the available data indicate considerable activity. Substantial evidence indicates that bortezomib-high-dose dexamethasone with or without a third drug (e.g., cyclophosphamide, thalidomide, or doxorubicin) is an appropriate option for patients with any degree of renal impairment.

Original languageEnglish (US)
Pages (from-to)2145-2163
Number of pages19
JournalClinical Cancer Research
Volume18
Issue number8
DOIs
StatePublished - Apr 15 2012

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Proxy
Multiple Myeloma
Thalidomide
Kidney
Therapeutics
Pharmacokinetics
Doxorubicin
Cyclophosphamide
Dexamethasone
Appointments and Schedules
Safety
Survival
lenalidomide
Bortezomib
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment. / Chanan Khan, Asher A; San Miguel, Jesús F.; Jagannath, Sundar; Ludwig, Heinz; Dimopoulos, Meletios A.

In: Clinical Cancer Research, Vol. 18, No. 8, 15.04.2012, p. 2145-2163.

Research output: Contribution to journalArticle

Chanan Khan, Asher A ; San Miguel, Jesús F. ; Jagannath, Sundar ; Ludwig, Heinz ; Dimopoulos, Meletios A. / Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment. In: Clinical Cancer Research. 2012 ; Vol. 18, No. 8. pp. 2145-2163.
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