Cancer encompasses a critical group of diseases with a profound impact on life prognoses and affects half of the Japanese population during their lifetime. Over the past decade, the oncology field has witnessed continuous progress in developing new anticancer drugs and treatment protocols, marking significant advances in cancer therapy. At the same time, the incidence of kidney diseases associated with cancer treatment has increased, leading to a growing demand for consultation with nephrologists in such cases.
In response to this situation, the “Clinical Practice Guidelines for Management of Kidney Injury during Anticancer Drug Therapy 2022” have been extensively revised after 6 years to support clinical decision-making by evaluating published evidence based on systematic reviews (1). Similar to the previous edition, these guidelines were jointly developed by the Japanese Society of Nephrology, the Japan Society of Clinical Oncology, the Japanese Society of Medical Oncology, and the Japanese Society of Nephrology and Pharmacotherapy, with the participation of experts from each society, and have undergone significant revisions to adapt to the rapid advances in cancer pharmacotherapy. In particular, the addition of clinical questions (CQs) related to molecularly targeted agents, especially immune checkpoint inhibitors (ICIs), is a prominent feature (Table 1).
CQs and GPSs in the Clinical Practice Guidelines for Management of Kidney Injury during Anticancer Drug Therapy 2022
The updated version is organized along the timeline of cancer care. Beginning with pretreatment assessment of renal function, chapter 2 addresses the appropriate selection and administration of anticancer drugs in patients with renal impairment. It then discusses measures to manage renal impairment caused by anticancer pharmacotherapy. In addition, this edition includes information on managing chronic kidney disease (CKD) in cancer survivors, a topic not covered in the previous version, demonstrating careful consideration to provide valuable insight at each stage. Furthermore, the committee compiled the background knowledge for each chapter and published four review articles (2–5).
The new guidelines also provide background information as a comprehensive review to support a wide range of health care practitioners. Additionally, good practice statements (GPSs) have been introduced, highlighting CQs from the first edition that have gained widespread acceptance since publication and those with uncertain prospects for future clinical trials.
Although this revised set of guidelines has already found validity in clinical practice, more publications are needed to assess the certainty of evidence for CQs that address clinically significant questions. In anticipation of continued advances in cancer care, it is hoped that research in this area will keep pace with these trends.
Muto S, et al. Chapter 1: Evaluation of kidney function in patients undergoing anticancer drug therapy, from Clinical Practice Guidelines for the Management of Kidney Injury during Anticancer Drug Therapy 2022. Int J Clin Oncol 2023; 28:1259–1297. doi: 10.1007/s10147-023-02372-4
Nishiyama H, et al. Chapter 2: Indications and dosing of anticancer drug therapy in patients with impaired kidney function, from Clinical Practice Guidelines for the Management of Kidney Injury during Anticancer Drug Therapy 2022. Int J Clin Oncol 2023; 28:1298–1314. doi: 10.1007/s10147-023-02377-z
Ando Y, et al. Chapter 3: Management of kidney injury caused by cancer drug therapy, from Clinical Practice Guidelines for the Management of Kidney Injury during Cancer Drug Therapy 2022. Int J Clin Oncol 2023; 28:1315–1332. doi: 10.1007/s10147-023-02382-2