How do you manage maintenance therapy in metastatic NSCLC, adenocarcinoma with good response to initial chemo (carboplatin, pemetrexed, pembrolizumab) with borderline renal function that has worsened during initial treatment?

Topics: Thoracic Malignancies • Medical Oncology

Would you stop all treatment after 4 cycles, or proceed with pembrolizumab alone, and would PD-L1 expression factor into your decision?

Answer from: Medical Oncologist at Community Practice

This is a difficult situation as it may not be possible to discern if creatinine elevation is related to pemetrexed versus immune checkpoint inhibitor (ICI)-nephritis; therefore, nephrology assessment would be crucial.I assume the question is regarding patients with significant renal impairment (i.e...

Answer from: Medical Oncologist at Academic Institution

I very much agree with Dr. @Umit Tapan's answer here. This is a common and vexing problem for the clinician- when facing renal toxicity- a real concern with short and long-term health consequences but in a setting that our patient also needs life-prolonging systemic therapy. Which d...

Comments

Medical Oncologist at NYU Winthrop Hospital
I will get renal consult, hold pemetrexed, I will ...

Medical Oncologist at Alvin & Lois Lapidus Cancer Institute Northwest Hospital
Great article!

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