Management Of Systemic Anticancer Treatment In Patients (Pts) Under Chronic Dialysis: A Raising Concern And An Emerging Population-Preliminary Results Of The French Candy (Cancer And Dialysis) Study

e13562 Background: 1 million people worldwide benefit from chronic dialysis with an increased rate in Western countries of 5% yearly. Significant improvements of chronic renal replacement therapy have led to prolonged survival. Due to mean age and heightened incidence of many cancers in dialyzed pts, the management of pts who suffer from both cancer and end-stage renal disease is challenging for oncologists and nephrologists. Specific questions were addressed to assess the efficacy/toxicity ratio, namely life expectancy, toxicity/dialysis clearance/optimal timing of chemotherapy. Methods: Retrospective multicentre review of dialysis centre charts for pts under dialysis who subsequently had a cancer. Results: Among 178 patients (66% male, median age 69) from 12 institutions, 35% were GU, 23% GI, lung 14%, hematologic 10%, head and neck 8%, or various others 10%. Most common histologies were adenocarcinomas 47%, of hematologic origin 17% and urothelial carcinomas 12%. Physical status was 0 48%, 1 18%, 2 30% and 3-4 4%. 36% had metastatic disease at diagnosis or diffuse hematologic malignancy. Median follow-up for living pts was 35 months and median survival 13 months. 32% were treated palliatively upfront: 21 for dialysis itself, 18 for cancer, 11 for age or other causes. Among 32% (N=57) treated with systemic treatment (carboplatin, fluorouracil, gemcitabine, cyclophosphamide, doxorubicin, melphalan, oxaliplatin, bortezomib), anti-cancer drugs ended prematurely, mostly for toxicity and/or death (78%). 72% of treated pts received at least one drug needing dosage adjustment and 82% at least one drug to be administered after dialysis sessions [www.siteGPR.com]. Overall, 88% of pts receiving anti-cancer drugs needed specific drug management because of dialysis. Conclusions: Survival was poor. Chemotherapy was indeed omitted or prematurely stopped in many cases. Specific scales are needed to select dialyzed pts for cancer treatment. Currently available specific drug management recommendations (dosage, timing) are being completed based on CANDY. Supported by an unrestricted educational grant from Amgen.