ORIGINAL ARTICLE Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage Giuseppe Rombola ` • Franco Vaira • Matteo Trezzi • Nadia Chiappini • Valeria Falqui • Francesco Londrino Received: 27 February 2014 / Accepted: 23 June 2014 Ó Italian Society of Nephrology 2014 Abstract Background Pemetrexed (Alimta Ò ) (PEM) is an antifo- late antineoplastic agent effective in several tumor types, such as non-small-cell lung cancer (NSCLC) and meso- thelioma, among others. It is almost exclusively excreted by the kidney and an eGFR lower 45 mL/min is a con- traindication for its use: above this level PEM adminis- tration is considered safe and dose adjustment is not required. Although there are some reported cases of PEM- induced renal injury, its incidence and the negative effects on patients’ outcome has not been systematically evaluated. Methods We report a retrospective evaluation on the incidence of PEM-induced renal injury in patients affected by NSCLC. Between June 2010 and March 2012 a total of 38 NSCLC patients were treated at our hospital. In 29 of them other possible cause of renal injury were excluded and thus they were eligible to be analysed. Results Although by protocol all of them had eGFR [ 45 mL/min at baseline, six patients (average eGFR 56.2 ± 11.5 mL/min/1.73 m 2 ) developed AKI (21 %). In these six patients PEM-induced myelosuppression was more severe and hospitalization was longer. Kidney function completely recovered in four patients whereas in the other two deterioration of renal function was irreversible. The number of patients with baseline eGFR \ 60 mL/min/ 1.73 m 2 was higher (4/6) in the group that developed AKI as compared to those who did not (6/23) (p \ 0.05). Conclusions There is no clear cut eGFR above which PEM may be used without potential risks of renal toxicity. If PEM has to be used, all the coexisting risk factors for AKI should be possibly corrected. Keywords Acute kidney injury Á Bone marrow toxicity Á Not small cell lung cancer Á Pemetrexed Introduction Pemetrexed (Alimta Ò ) (PEM) is an antifolate antineoplastic agent with a broad-spectrum activity in multiple tumor types. It is widely used in locally advanced or metastatic non-small cell lung cancer (NSCLC) and mesothelioma. It may be used alone or in combination with other antineoplastic drugs such as cisplatin or carboplatinum for the treatment of patients with unresectable malignant mesothelioma [1–7]. According to the official FDA information on side effects and uses, no dosage adjustment is needed in patients whose creatinine clearance is above 45 mL/min. Below this level (given the insufficient number of patients cur- rently studied) PEM administration is not advisable [8]. However, cancer patients are quite often affected by sarcopenia and malnutrition, they could be exposed to several other potential nephrotoxic medications (i.e. FANS, diuretics, ACE-inhibitors, radiocontrast agents) or experi- ence intestinal disturbances and dehydration and all these conditions may make the estimated glomerular filtration rate unreliable. Thus, even if the eGFR is apparently well G. Rombola ` Á M. Trezzi Á N. Chiappini Á V. Falqui Á F. Londrino Nephrology and Dialysis Unit, St. Andrea Hospital, La Spezia, Italy G. Rombola `(&) Nephrology Dialysis and Kidney Transplant, Macchi Foundation Hospital, Via L. Borri 51, Varese, Italy e-mail: giuseppe.rombola@ospedale.varese.it F. Vaira Oncology Unit, St. Andrea Hospital, La Spezia, Italy 123 J Nephrol DOI 10.1007/s40620-014-0117-5