ESPN 54th Annual Meeting

ESPN 2022


 
Study for the evaluation of toxicity and renal function in pediatric patients treated with Bevacizumab (BERETOX)
PEDRO ARANGO SANCHO 1 ANA CRISTINA AGUILAR RODRíGUEZ 1 MARTA JIMéNEZ MORENO 1 ELENA CODINA SAMPERA 1 RAQUEL JIMéNEZ GARCíA 1 YOLANDA CALZADA BAñOS 1 OFELIA CRUZ MARTíNEZ 1 ÁLVARO MADRID ARIS 1

1- HOSPITAL SANT JOAN DE DéU
 
Introduction:

Anti-vascular endothelial growth factor (VEGF) antibodies,such as Bevacizumab (BVZ),act on tumor angiogenesis trying to stabilize/remit the tumor mass.This is widely expressed in the glomerulus,playing a key role in its maintenance and proliferation,involving endothelium and podocytes.The objective of our study was to describe the nephrotoxicity associated with treatment with BVZ in pediatrics,as well as the study of kidney damage and function after its withdrawal

Material and methods:

Retrospective study including 66 patients affected by solid tumors of the CNS treated between August 2006 and November 2020 with BVZ,without previous nephropathy or history of nephrotoxicity during their treatment.The mean age of the patients was 6.65 years and their total survival from diagnosis of about 5.04 years,with up to 57.6% of the cohort dying during the study. All patients received prior and/or adjuvant therapies including nephrotoxic drugs (cyclosporine, cisplatin or cyclophosphamide) or radiotherapy (50%)

Results:

The indication for BVZ in the majority was tumor progression (n=48; 80%),with complete/partial remission in 17%.The mean treatnebt duration was 13.66 months (1-62),18.3 months in nephrotoxicity patients (2.8-34.2).Survival after BVZ was>90 months in 9% of cases,most frequent being 12-36 months (22.5%).Proteinuria and hypertension was observed in 15.10%. When comparing the cumulative dose and duration of treatment with the finding of proteinuria and hypertension,a correlation was observed(100%/50% if >30g and 6.3% /3.2% if >2 years).Long-term analysis of renal function was not possible in the entire cohort due to high mortality (57%),with only 28 patients in long-term follow-up among them,if we exclude the patients who received a nephrotoxic agent after BVZ,only two patients who received BVZ without previous nephrotoxicity (7.14%) presented a glomerular filtration deficit (83 and 88ml/min/1.73 m2).

Conclusions:

Long-term renal evaluation in these patients is highly hampered by poor survival,probable previous nephrotoxic damage,and the difficulty of reliably determining renal function in historical cohorts.All patients with proteinuria and hypertension due to BVZ normalized these parameters after its withdrawal.The alterations observed in long-term renal function are minimal and do not allow conclusions to be drawn.Knowledge of the mechanisms of nephrotoxicity,as well as its long-term effects,is essential for the development of new guidelines and preventive strategies that minimize the risk and impact on survival of these patients