Sorafenib should be used “with caution” in patients with metastatic renal cell carcinoma (mRCC) who are receiving hemodialysis treatments, according to a systematic review of literature.1 The study is the first to investigate this issue, according to the authors.

Sorafenib is a multi-kinase inhibitor that is effective in terms of response rate and progression-free survival (PFS) for patients with mRCC who have previously received 1 systemic therapy, although most guidelines do not currently recommend it as a first-line therapy.

“The lack and heterogeneity of data regarding use of sorafenib in hemodialysis patients affected by mRCC encouraged us to review literature about this topic,” Alessandro Leonetti, MD, of the University Hospital of Parma, Italy, wrote in an email to Cancer Therapy Advisor. “No systematic review has been performed until now, and data are limited to few case reports and single center experiences.”

“Patients affected by mRCC undergoing hemodialysis are often not included in clinical trials because of their altered pharmacokinetics and comorbidities,” said Dr Leonetti. “More prospective studies, including this special population, are needed to give better clinical guidance.”

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Dr Leonetti and his colleagues evaluated literature about mRCC dialysis patients receiving sorafenib from January 1946 to August 2015. A total of 11 articles were included; 36 patients. The outcomes the researchers investigated were pharmacokinetics, toxicity, response rate, PFS, and overall survival (OS).