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Childhood Cancer Survivors Who Received Nephrotoxic Therapy May Be at Greater Risk for Late Renal Problems

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Key Points

  • Compared with adult survivors of childhood cancers who were not given nephrotoxic therapy, adult survivors who were treated with certain chemotherapy drugs or kidney surgery had worse kidney function, which did not recover over time.
  • The loss in glomerular function started early, especially for childhood cancer survivors treated with ifosfamide, higher doses of cisplatin, and nephrectomy, and appeared to be persistent, putting survivors at greater risk for premature chronic renal failure.
  • Special attention should be given to childhood cancer survivors treated with nephrotoxic therapy to detect kidney function deterioration.

A large study assessing glomerular function in adult survivors of childhood cancers who were treated with certain chemotherapy drugs or kidney surgery found that they had worse kidney function, which did not recover over time, compared with adult survivors who were not given nephrotoxic therapy. The study was published in Cancer Epidemiology, Biomarkers & Prevention.

Renée L. Mulder, PhD, Research Associate in the Department of Pediatric Oncology at Emma Children’s Hospital/Academic Medical Center (EKZ/AMC) in Amsterdam, the Netherlands, and colleagues identified 1,122 eligible adult survivors of childhood cancer survivors who had visited the Late Effects of Childhood Cancer outpatient clinic at EKZ/AMC between 1996 and 2010. The study participants were 18 years or older and were followed for 4 to 42 years after a diagnosis and treatment for cancer. All the study participants had undergone glomerular function testing and were assessed for their glomerular filtration rate and glomerular dysfunction.

Study Results

The researchers were interested in investigating the possible effect kidney-damaging treatments had on kidney function over time. Treatments included the chemotherapy drugs ifosfamide, cisplatin, carboplatin, high-dose methotrexate, and high-dose cyclophosphamide; radiation therapy to the kidney region; and partial or complete surgical removal of the kidney. The scientists found that compared with childhood cancer survivors who did not receive kidney-damaging treatments, those who were treated with potentially nephrotoxic therapy, especially ifosfamide or cisplatin, and those who underwent nephrectomy had lower glomerular filtration rate and higher glomerular dysfunction, which persisted throughout the follow-up period. In addition, survivors who had been treated with high doses of cisplatin had the highest rate of kidney function deterioration.

Risk for Premature Renal Failure

“The loss in glomerular function starts early, especially for [childhood cancer survivors] treated with ifosfamide, higher doses of cisplatin, and nephrectomy, and seems to be persistent. We have an indication that [childhood cancer survivors] treated with higher doses of cisplatin experience faster decline than other [childhood cancer survivors],” wrote the researchers.

As glomerular function continues to deteriorate, adult survivors of childhood cancer are at an increased risk for premature chronic renal failure, said the researchers. Chronic kidney disease not only affects quality of life, but it can lead to premature comorbidities, such as cardiovascular disease, anemia, bone disease, and malnutrition, according to the researchers.

Special attention should be given to childhood cancer survivors who are treated with nephrotoxic therapy to detect kidney function deterioration.

The study authors reported no conflict of interest.

The study was funded by the Tom Voüte Fund, Amsterdam.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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