chemo after renal toxicity - 1257748

cynthia8265
Posts:4

Stage 4 NSCLC . Diagnosed May 2012. Adenocarcinoma with spinal mets. 6 rounds cisplatin/alimta. 2 cycles alimta maintenance. Traditional palliative radiation on spine 10 treatments. Significant reduction in tumor size. Tumor now 2.4 by 2.0

After this my creatinine level rose to 2. 4. Chemo was stopped 5 months ago due to toxicity. Now creatinin is 1.7. After 5 months CT scan showed "suspected slight progression of lung tumor". Spinal mets remain stable.

Any suggestions of chemo treatment that can work given the renl toxicity? Tested for mutations- no luck there.

Any other treatment suggestions to explore?

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Reply # - July 6, 2013, 06:33 PM

Dr West
Posts: 4735

Taxanes like Taxol (paclitaxel), Taxotere (docetaxel), or Abraxane (nab-paclitaxel), or potentially other commonly used NSCLC drugs like Gemzar (gemcitabine) are primarily metabolized through the liver and can potentially be used for someone whose kidney function isn't as good as we'd prefer. However, if progression is very minimal and slow, the risk may exceed benefit treating right now with rather slight, subtle progression, especially since the risks from treatment are greater with the kidney disease. We need to always be mindful of anticipated benefit vs. risk for any particular patient: in someone with slow, asymptomatic progression and a higher risk of side effects than "average", it makes sense to be very judicious about giving more treatment, especially when you're really treating the scan findings and not new problems in the patient.

Good luck.

-Dr. West

Reply # - July 7, 2013, 03:03 PM

cynthia8265
Posts: 4

Dear Dr. West,

Thank you from the bottom of my heart for your rapid and frank reply. After listening to my doctor's options I am deciding to " wait and watch" on the chemo.

I am exploring SBRT for the lung tumor. I have just been notified that I am approved for treatment by Shands Hospital at University of Florida, Jacksonville. I am inclined to do it, as I think it would
have less side effects and a greater chance of eliminating the tumor than chemo, given my toxicity issues.

I am certain everyone here, and their families greatly appreciates the service you do.

May God Bless you and your family

Reply # - July 8, 2013, 12:56 AM

watu
Posts: 45

My dad's experience with Taxotere in terms of renal toxicity was absolutely good. My father has just one kidney, with a long-term moderate renal insufficiency. His creatinine levels have been in the range of 2.4 - 2.6 for the last 20 years and did not worsen with Taxotere, although the treatment was certainly challenging with other significant side effects.

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