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Abstract: SA-PO155

Short- and Long-Term Adverse Kidney Outcomes of CDK 4/6 Inhibitors for Breast Cancer

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Hanna, Paul, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
  • Strohbehn, Ian Austin, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
  • Wang, Qiyu, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
  • Ouyang, Tianqi, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
  • Gupta, Shruti, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Wander, Seth, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
  • Sise, Meghan E., Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States
Background

Cyclin-dependent kinase (CDK) 4/6 inhibitors have transformed the treatment landscape for patients with advanced or metastatic breast cancer. Small studies have suggested that CDK 4/6 inhibitors may interfere with creatinine secretion. Yet, there are also case reports of biopsy-proven acute tubular necrosis and acute interstitial nephritis in patients receiving CDK 4/6 inhibitors. We sought to study the short and long-term kidney outcomes in a large cohort of women treated with CDK 4/6 inhibitors.

Methods

Retrospective cohort study of women receiving abemaciclib or palbociclib at two cancer centers. We compared the risk of acute 20% estimated glomerular filtration rate (eGFR) decline within 30 days of treatment initiation and the 1-year risk of a composite adverse kidney outcome (>40% eGFR decline sustained >90 days, eGFR <10ml/min/1.73m2, or need for dialysis).

Results

253 women received abemaciclib and 238 received palbociclib. Mean age was 61 years (SD=13), baseline eGFR was 87ml/min/1.73m2 (SD = 21); there were no significant differences between the two cohorts at baseline. The rate of acute 20% eGFR decline within 30 days was significantly higher in patients receiving abemaciclib vs. palbociclib (60% vs. 22%, p<0.001). After adjusting for age, race/ethnicity, baseline eGFR, comorbidities, and medication use, the adjusted odds ratio was 5.38, CI: 3.60 – 8.13, p<0.001). Despite the initial decline in eGFR, kidney function was stable over the next 11 months for both abemaciclib and palbociclib-treated patients (Figure), and no patients experienced the composite adverse kidney outcome at 1 year.

Conclusion

CDK 4/6 inhibitors cause an acute decline in eGFR that is significantly more common in patients receiving abemaciclib than palbociclib. Our data suggest benign inihibition of creatinine secretion, as eGFR stabilized, and there was no progressive decline in kidney function or kidney failure events.

Figure 1. Mean eGFR over 12 months after starting CDK 4/6 inhibitors