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Renal Toxicities of Targeted Therapies

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Abstract

With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. This review will focus on these renal toxicities from commonly used targeted agents. This review discusses the mechanisms of these side effects and management strategies. Anti-vascular endothelial growth factor (VEGF) agents including the monoclonal antibody bevacizumab, aflibercept (VEGF trap), and anti-VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs) all cause hypertension, whereas some of them result in proteinuria. Monoclonal antibodies against the human epidermal growth factor receptor (HER) family of receptors, such as cetuximab and panitumumab, cause electrolyte imbalances including hypomagnesemia and hypokalemia due to the direct nephrotoxic effect of the drug on renal tubules. Cetuximab may also result in renal tubular acidosis. The TKIs, imatinib and dasatinib, can result in acute or chronic renal failure. Rituximab, an anti-CD20 monoclonal antibody, can cause acute renal failure following initiation of therapy because of the onset of acute tumor lysis syndrome. Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, can result in proteinuria. Discerning the renal adverse effects resulting from these agents is essential for safe treatment strategies, particularly in those with pre-existing renal disease.

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Acknowledgments

We are grateful to Dr. Kirk Foster, Department of Pathology/Microbiology, University of Nebraska Medical Center for providing the photomicrographs depicted in Fig. 1.

Conflict of Interest

None of the other authors have any conflicts of interest with any of the subject matter of this work. Dr. Apar Kishor Ganti does, however, report personal fees from Boehringer-Ingelheim, Otsuka Pharmaceuticals, and Biodesix Inc., outside the submitted work.

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Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Creighton University, Omaha, NE, USA

    Anum Abbas & Mohsin M. Mirza

  2. Division of Oncology and Hematology, Department of Internal Medicine, VA-Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA

    Apar Kishor Ganti

  3. Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, 983040 Nebraska Medical Center, Omaha, NE, 68198-3040, USA

    Ketki Tendulkar

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  1. Anum Abbas
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  2. Mohsin M. Mirza
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  4. Ketki Tendulkar
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Correspondence to Ketki Tendulkar.

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Abbas, A., Mirza, M.M., Ganti, A.K. et al. Renal Toxicities of Targeted Therapies. Targ Oncol 10, 487–499 (2015). https://doi.org/10.1007/s11523-015-0368-7

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