From the Guidelines
Impaired renal function is not an absolute contraindication for Libtayo (cemiplimab) therapy, but it requires careful monitoring and consideration of the potential risks of immune-related renal toxicity. According to the American Society of Clinical Oncology clinical practice guideline 1, checkpoint inhibitor therapy, including cemiplimab, appears to be safe in patients with baseline renal impairment from a nonimmune basis. However, patients with a renal allograft are at high risk of rejecting the transplanted kidney and requiring dialysis. Key considerations for using cemiplimab in patients with impaired renal function include:
- Monitoring renal function (serum creatinine) prior to every dose of cemiplimab therapy 1
- Holding therapy if new elevations in creatinine are detected, and evaluating for other potential causes 1
- Treating empirically for immune-related renal toxicity if no other causes are identified 1
- Regular monitoring of renal function throughout treatment to detect changes that might indicate developing nephrotoxicity It is essential to weigh the potential benefits of cemiplimab therapy against the risks of immune-related renal toxicity and to consider alternative treatment options if necessary. Patients with impaired renal function should be closely monitored, and their treatment plans should be individualized based on their specific needs and circumstances.
From the Research
Impaired Renal Function and Libtayo (Cemiplimab)
- There is no direct evidence in the provided studies that specifically addresses whether impaired renal function is a contraindication for Libtayo (cemiplimab) 2, 3, 4, 5, 6.
- However, the studies suggest that impaired renal function can affect the pharmacokinetics and pharmacodynamics of various drugs, including anticancer agents 3, 4, 6.
- Some drugs, such as cisplatin, etoposide, and ifosfamide, require dose adjustment or are contraindicated in patients with impaired renal function 3, 4.
- The use of serum creatinine as a screening test for impaired renal function may not always be reliable, and estimated glomerular filtration rate (eGFR) may be a more accurate measure 5.
- Immune checkpoint inhibitors, such as Libtayo (cemiplimab), can cause kidney injury, including acute interstitial nephritis, which may require treatment with steroids 6.
Renal Function and Drug Therapy
- Patients with impaired renal function may require dose adjustments or alternative treatments for various medications, including anticancer agents 3, 4, 6.
- The pharmacokinetics and pharmacodynamics of drugs can be altered in patients with impaired renal function, and careful monitoring and dose adjustment may be necessary 3, 4, 6.
- The use of diuretics, magnesium supplementation, and adequate hydration may be necessary to avoid renal impairment in patients receiving certain anticancer agents, such as cisplatin 6.