Novel therapeutic agents for the management of multiple myeloma patients with renal impairment
Cet article passe en revue les travaux récents sur les traitements (bortezomib, thalidomide et lenalidomide) ayant démontré une efficacité chez les patients atteints d'un myélome multiple et présentant une insuffisance rénale
Renal impairment is a major complication of multiple myeloma (MM). 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 outcome is comparable with those without renal impairment. Therapies that offer substantial activity in this setting are needed. Bortezomib, thalidomide, and lenalidomide have substantially improved survival of MM patients; 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. Lenalidomide pharmacokinetics are affected due to its renal route of excretion; dose adjustments are recommended for moderate/severe impairment. Substantial evidence has emerged demonstrating 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 available data indicate considerable activity. Substantial evidence is available for bortezomib-high-dose dexamethasone with/without a third drug (e.g. cyclophosphamide, thalidomide, doxorubicin) being appropriate options for patients with any degree of renal impairment.Conclusions: