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Classification of renal dysfunction for chemotherapy dose modifications

The following is a suggested classification of renal dysfunction for the purpose of developing guidelines for chemotherapy dosing.

The eviQ classification of renal dysfunction is adapted from the National Kidney Foundation (NKF) and National Cancer Institute Organ Dysfunction Working Group (NCI OWG) definitions.

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eviQ classification of renal dysfunction 

Renal dysfunction Creatinine clearance (mL/min)
Moderate 30 to 50
Severe less than 30

eviQ dose modification guidelines

Having established the above definitions for renal dysfunction, we have developed the following guidelines for dose modifications by classifying drugs according to their renal clearance, therapeutic index and by adapting recommendations from individual product information, micromedex and references listed below.rr

Group 1: Drugs with high renal clearance and narrow therapeutic ratio

Renal dysfunction  
Moderate and severe Omit [drug]

Group 2: Drugs with high renal clearance

Renal dysfunction  
Moderate Reduce [drug] by 50 %
Severe Omit [drug]

Group 3: Drugs with moderate renal clearance

Renal dysfunction  
Moderate Reduce [drug] by 25 %
Severe Reduce [drug] by 50 %

Group 4: Drugs with minimal renal clearance

Renal dysfunction  
Moderate No dose modification necessary
Severe Reduce [drug] by 25 %

Note: This is not a complete list of drugs used in cancer treatments. It has been developed for use with medical oncology protocols. Dose modification guidelines for haematology protocols may differ. Please refer to individual haematology protocols for more information.

Group 1 Group 2 Group 3 Group 4
 
  • Dacarbazine
  • Methotrexate
  • Pemetrexed
  • Topotecan rrr
  • Bleomycin*
  • Capecitabine* rr
  • Cisplatin**
  • Cyclophosphamide
  • Eribulin*
  • Etoposide
  • Fluorouracil r
  • Gemcitabine
  • Irinotecan***
  • Ifosfamide
  • Lomustine
  • Mitomycin*
  • Procarbazine
  

* Limited data exists. Rather than a 50% dose reduction in severe renal dysfunction, omission is recommended. 
** Substitution with an alternative where available should be considered in both moderate and severe renal dysfunction. If no alternative available, cisplatin should be omitted because of its combination of renal clearance and nephrotoxicity.
*** Irinotecan is placed in Group 3 as a caution because of its association with diarrhoea which may result in acute renal failure.

Drugs which do not follow the above standard recommendations 
Carboplatin  Recalculate AUC* 
Oxaliplatin No dose modifications in moderate renal impairment but omit in severe renal impairmentr
Raltitrexed Refer to protocol 

* Minimal safety data is currently available for use in patients with GFR less than 30 mL/min.

Drugs which do not require dose modifications for renal impairment
  • Cabazitaxel
  • Docetaxel
  • Doxorubicin
  • Epirubicin
  • Mitozantrone
  • Paclitaxel/nab-paclitaxel
  • Temozolomide
  • Vinblastine
  • Vincristine
  • Vinorelbine
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Version 2

Date Summary of changes

31/05/2017

Transferred to new eviQ website. Version number changed to V.2.
ACI ID 69 old site.

While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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https://www.eviq.org.au/p/3249

27 Feb 2021