[Cancer treatment-induced nephrotoxicity: BCR-Abl and VEGF inhibitors]

G Ital Nefrol. 2010 Sep-Oct:27 Suppl 50:S70-4.
[Article in Italian]

Abstract

The nephrotoxicity of some cancer drugs is well known. Given the rapid development of cancer research, careful assessment of patients treated with new drugs, which may have new toxicity profiles, is mandatory. The nephrotoxicity of cisplatin is likely due to inhibition of autophagy priming, while that of methotrexate is related to direct tubular toxicity and intratubular precipitation. Both can be prevented by adequate hydration. The mechanism of radiation nephropathy development is unclear, but chronic oxidative stress and inflammation seem to play a key role. Mesangiolysis is a characteristic feature, followed by vascular alterations, atrophy, fibrosis, and necrosis. Inhibitors of vascular endothelial growth factor (VEGF), such as bevacizumab, sunitinib, and sorafenib, interfere with angiogenesis. Bevacizumab is a humanized monoclonal antibody which binds to circulating VEGF. Sunitinib and sorafenib are small molecules inhibiting tyrosine kinase of the intracellular domain of the VEGF receptor. Treatment with anti-VEGF drugs is frequently complicated by proteinuria, acute renal failure, and hypertension. The most frequent histological lesion is thrombotic microangiopathy. Inhibitors of the BCR-Abl tyrosine kinase domain on the Philadelphia chromosome (imatinib, nilotinib and dasatinib) may cause acute renal failure.

Publication types

  • English Abstract

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Cisplatin / adverse effects
  • Fusion Proteins, bcr-abl / antagonists & inhibitors
  • Humans
  • Interferons / adverse effects
  • Kidney Diseases / chemically induced
  • Kidney Diseases / etiology*
  • Methotrexate / adverse effects
  • Radiotherapy / adverse effects*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors

Substances

  • Antineoplastic Agents
  • Vascular Endothelial Growth Factor A
  • Interferons
  • Fusion Proteins, bcr-abl
  • Cisplatin
  • Methotrexate