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World J Clin Cases. Jul 6, 2022; 10(19): 6360-6369
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6360
Review of epidermal growth factor receptor-tyrosine kinase inhibitors administration to non-small-cell lung cancer patients undergoing hemodialysis
Chou-Chin Lan, Po-Chun Hsieh, Chun-Yao Huang, Mei-Chen Yang, Wen-Lin Su, Chih-Wei Wu, Yao-Kuang Wu
Chou-Chin Lan, Chun-Yao Huang, Mei-Chen Yang, Wen-Lin Su, Chih-Wei Wu, Yao-Kuang Wu, Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
Po-Chun Hsieh, Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
Author contributions: Lan CC, Hsieh PC, Huang CY, and Yang MC contributed to data curation; Lan CC and Hsieh PC contributed to formal analysis; Lan CC, Huang CY, Yang MC, Su WL, Wu CW, and Wu YK contributed to investigation; Lan CC and Wu YK contributed to conceptualization; Lan CC, Su WL, and Wu CW contributed to methodology; Lan CC, Hsieh PC, Huang CY, Yang MC, and Wu YK contributed to project administration; Lan CC and Wu YK contributed to funding acquisition; Lan CC, Wu YK, and Hsieh PC contributed to writing; Huang CY, Yang MC, and Wu YK contributed to validation; Lan CC and Hsieh PC contributed to the original draft; Lan CC contributed to review and editing; Wu YK contributed to supervision, visualization, review, and editing.
Supported by the Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. TCRD-TPE-108-RT-4(3/3; and No. TCRD-TPE-109-59.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yao-Kuang Wu, MD, Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan.drbfci@yahoo.com.tw
Received: January 23, 2022
Peer-review started: January 23, 2022
First decision: March 23, 2022
Revised: April 1, 2022
Accepted: May 12, 2022
Article in press: May 12, 2022
Published online: July 6, 2022
Abstract

Non-small-cell lung cancer (NSCLC) causes significant mortality worldwide. Patients with chronic renal failure have an increased risk of developing lung cancer. NSCLC Patients with chronic renal failure undergoing hemodialysis (HD) often exhibit poor performance, and chemotherapy is generally contraindicated. Oral epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are effective treatment agents for NSCLC patients. However, the benefits and adverse effects of EGFR-TKIs in NSCLC undergoing HD are known. There are no clinical studies on the effects of EGFR-TKIs on NSCLC patients undergoing HD. We reviewed all previous case reports about EGFR-TKIs in NSCLC patients undergoing HD. It is difficult to design studies about the effects of EGFR-TKIs in patients undergoing HD, and this review is quite important. EGFR-TKIs are well tolerated in patients undergoing HD. The main routes of elimination of EGFR-TKIs are metabolism via the liver, and renal elimination is minor. The recommended doses and pharmacokinetics of these EGFR-TKIs for patients undergoing HD are similar to those for patients with normal renal function. The plasma protein binding of EGFR-TKIs is very high, and it is not necessary to adjust the dose after HD. In conclusion, EGFR-TKIs are effective and well tolerated in patients undergoing HD.

Keywords: Hemodialysis, Non-small-cell lung cancer, Epidermal growth factor receptor, Tyrosine-kinase inhibitors

Core Tip: Lung cancer causes significant mortality worldwide. Patients with chronic renal failure increase the difficulty of treatment. Oral epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are effective treatment agents for non-small-cell lung cancer (NSCLC) patients. According to this review, EGFR-TKIs are suitable for treating NSCLC patients undergoing hemodialysis (HD) owing to their good response rates and tolerance. The main routes of elimination of EGFR-TKIs are via the liver and excretion via feces. The recommended doses and pharmacokinetics of EGFR-TKIs for patients undergoing HD are similar to those with normal renal function. The plasma protein binding of EGFR-TKIs is high, and it is not necessary to adjust the dose after HD.