How would you treat a patient with end-stage renal disease, a germline BRCA1 mutation, and pT1c pN0 TNBC s/p mastectomy?

To better address this question, I have consulted our phenomenal specialty pharmacist at our breast cancer program, Dr. Michael Berger. Based on the information he provided, doxorubicin and paclitaxel can be given at full doses in patients with end-stage renal disease (ESRD) as these agents are metabolized predominantly by the liver and are not dialyzable. Pegfilgrastim and dexamethasone can also be safely given. Cyclophosphamide is partially metabolized by the kidneys, but it can be safely given to patients with ESRD as long as its dose is reduced by 50%.

Since this patient meets the criteria for adjuvant chemotherapy based on TNM stage and triple-negative status, I would proceed with 4 cycles of dose-dense doxorubicin and cyclophosphamide ...