Which CRC Regimens Are More Likely to Harm Kidneys?

M. Alexander Otto, PA, MMS

May 17, 2022

The study was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Among the various chemotherapy options for metastatic colorectal cancer (CRC), FOLFIRI + bevacizumab is the most likely to cause acute kidney injury (AKI).

  • Prognostic factors for AKI include old age, low body mass index (BMI), proteinuria at baseline, as well as regimens containing bevacizumab, most notably, FOLFIRI + bevacizumab.

Why This Matters

  • The findings can help steer patients at risk for renal injury away from the regimens most likely to cause it.

  • The results also build a case for greater renal monitoring of at-risk patients.

Study Design

  • The team reviewed data on 472 patients with metastatic CRC who had received standard triplet regimens — FOLFOX or FOLFIRI plus either bevacizumab or cetuximab.

  • The median age of the patients was 62 years.

  • Renal function — assessed using estimated glomerular filtration rate (eGFR) — was checked every 3 months for 12 months.

Key Results

  • For all four regimens, patients' median eGFR fell from 90.9 mL/min/1.73 m2 at baseline to 80.1 mL/min/1.73 m2 at 12 months.

  • Median 12-month eGFR among the 97 patients receiving FOLFIRI + bevacizumab fell the most — to 74.9 mL/min/1.73 m2.

  • The overall incidence of AKI was 9.1% at 12 months.

  • AKI incidence was lowest among the 57 patients treated with FOLFOX + cetuximab, at 2.1%. It was highest among the group that received FOLFIRI + bevacizumab, at 19.2%.

  • Being older than 64 years, having BMI below 18.5 kg/m2, and baseline proteinuria were independently associated with lower eGFR.

  • Concomitant medications, comorbidities, and other chemotherapy regimens did not significantly influence AKI development.


  • The study was a single-center retrospective analysis.

  • Survival outcomes were not reported.

  • The overall incidence of AKI was lower than reported in previous studies, possibly owing to the definition of AKI and heterogeneity of the study population.


  • There was no funding for the study, and the investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "Prognostic Factors for Renal Function Deterioration During Palliative First-Line Chemotherapy for Metastatic Colorectal Cancer," led by Ah Reum Lim of the Korea University Anam Hospital. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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