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Open Access Case report

Safety and efficacy of vemurafenib in end stage renal failure

Mahesh Iddawela12*, Sarah Crook1, Leah George1, Amit Lakkaraju3, Nihal Nanayakkara1, Roland Hunt1 and William R Adam2

Author Affiliations

1 Goulburn Valley Health, Graham Street, Shepparton 3630, Australia

2 Rural Health Academic Center, University of Melbourne, Graham Street, Shepparton 3630, Australia

3 Goulburn Valley Imaging, Graham Street, Shepparton 3630, Australia

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BMC Cancer 2013, 13:581  doi:10.1186/1471-2407-13-581

Published: 6 December 2013

Abstract

Background

Serine-threonine inhibitors, such as vemurafenib, are being used increasingly in cancer treatment, and the toxicity and therapeutic benefit need to be balanced carefully both before and during treatment.

Case presentation

A patient with metastatic melanoma and end stage renal failure who was on peritoneal dialysis was treated with the serine-threonine kinase inhibitor, vemurafenib. After 5 months of treatment, a substantial response to vemurafenib was observed using imaging, but when he developed a prolonged QTc interval (common toxicity criteria (CTC) grade 3), treatment was interrupted. Vemurafenib was restarted at a reduced dose when the QTc interval returned to normal. The patient has had a significant response to vemurafenib and continued on treatment for 12 months after beginning the therapy.

Conclusion

This is the first reported case of end stage renal failure in a patient who is taking vemurafenib. Although the patient developed QTc prolongation, it appears to be asymptomatic, and was managed with dose reduction. This case highlights the need for closer QTc monitoring at the start and during treatment.

Keywords:
Renal excretion; Metastatic melanoma; Vemurafenib