Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations.

BACKGROUND: Elderly cancer patients commonly have renal function decline. This warrants particular caution during the administration of renally excreted cancer drugs or those with established nephrotoxicity.
DESIGN: An International Society for Geriatric Oncology task force was formed to discuss treatment recommendations for this group of patients.
RESULTS: Before drug therapy, the assessment and optimization of hydration status and evaluation of renal function is required. Serum creatinine alone is insufficient as a means of evaluating renal function, and creatinine clearance should at least be calculated in every patient by the abbreviated modification of diet in renal disease or Cockcroft-Gault equations. In the extremes of obesity and cachexia and at very high and low creatinine values, no single tool is really accurate. In these patients, the best estimate of glomerular filtration rate is provided by direct methods such as (51)Cr-EDTA or inulin measurement. Within each drug class, preference may be given to agents less likely to be influenced by renal clearance, which are minimally nephrotoxic, or for which appropriate methods of prevention for renal toxicity exist. Coadministration of known nephrotoxic drugs should be avoided or minimized.
CONCLUSIONS: Future trials should be designed to present data in a way that allows evaluation of the contribution of renal function to toxicity and efficacy.