Abstract: SA-PO1232
Contemporary Use of Anticancer Drugs Requiring Dose Modification for GFR in US Adults with CKD
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Tajerian, Amin, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Highfield, Linda, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Ferguson, Gayla, The University of Texas Health Science Center at Houston, Houston, Texas, United States
- Pezzia, Carla, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Liu, Harry, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Shafi, Tariq, Baylor Scott & White Medical Center Temple, Temple, Texas, United States
Background
CKD affects up to 32% of patients with cancer, with two-thirds having GFR 30–59 mL/min/1.73 m2, the range where anticancer drug dosing is most affected. The American Society of Onco-Nephrology (ASON) classifies anticancer drug dose recommendations into four categories based on eGFR: Full Dose; Full Dose with Monitoring of Adverse Events; Dose Modification; or AVOID. KDIGO recommends measured GFR (mGFR) for anticancer drug dosing, but mGFR is rarely available. We evaluated real-world use of renally adjusted anticancer drugs in patients with CKD to assess the clinical need for mGFR-guided dosing.
Methods
We used de-identified electronic health record data from 30 U.S. health systems in the Truveta network. Adults aged ≥18 years who received renally cleared anticancer drugs from 2020 to 2026, and had an eGFR-creatinine from 15-59 mL/min/1.73 m2 were included. We assessed the prescription of renally cleared anticancer drugs, as defined by ASON, across eGFR categories.
Results
We identified approximately 69,000 adults with CKD (eGFR 15-60 mL/min/1.73 m2) who received renally cleared anticancer drugs. The median age was 77.5 years (IQR, 67.8–83.9); 51.7% were male; and 11.5% Black. Across approximately 130,000 renally cleared anticancer drug prescriptions, 61.5% were classified as Full Dose, 26.6% Full Dose with Monitoring, and 11.8% as requiring Dose Modification. Overall, approximately 38.5% of prescriptions qualified for a modified management strategy (enhanced monitoring or dose adjustment) due to low eGFR. The most common agents were pembrolizumab (10.1%), paclitaxel (9.7%), doxorubicin (9.4%), carboplatin (8.1%), gemcitabine (7.9%), rituximab (7.7%), cyclophosphamide (7.3%), and cisplatin (4.6%).
Conclusion
Anticancer drugs that require dose adjustment based on GFR are frequently used in patients with CKD. Our findings highlight a potential gap in precision dosing due to the lack of availability of mGFR and underscore the need for its wider availability to optimize cancer care for individuals with CKD and cancer.