Administrative and Legal Aspects of Anticancer Therapy in Patients with Comorbid Renal Insufficiency

Justification: Recently, the number of cancer patients with other diseases, particularly chronic kidney disease (CKD), has increased significantly. Unfortunately, there are no regulatory documents that clearly outline anticancer therapy for these patients. This can lead to disputes and conflicts due to the refusal of pathogenetic treatment for safety reasons or because simplified regimens are insufficiently effective. This article discusses relevant recommendations and scientific publications on this topic by domestic and foreign authors. Notably, the Russian "Practical Recommendations on the General Principles of Antineoplastic Drug Therapy" (RUSSCO, 2022) does not impose any limitations on antineoplastic therapy for patients with CKD. The only exception is cisplatin, which is not recommended for use with a glomerular filtration rate (GFR) below 50–60 ml/min. Other authoritative domestic sources do not impose strict restrictions based on the stage of CKD either. Foreign literature covers the problem of antineoplastic therapy for patients with conservative-curable renal failure in a one-sided manner. Issues related to the technical recalculation of drug dosages are mainly considered, rather than the effectiveness of treatment regimens. Recommendations exist for adjusting the dosage of antineoplastic drugs depending on the hemodialysis regimen. Additionally, there are many publications on paraneoplastic nephropathies, which involve damage to the nephron with immune system involvement. Activation of antineoplastic therapy can lead to remission of nephropathy. Currently, contraindications to chemotherapy for tumors in chronic kidney disease (CKD) are underdeveloped. Legally, such treatment can be carried out for any kidney function up to the terminal stage of CKD. This contradicts the principle that "treatment should not be more dangerous than the disease." Conclusion: The problem of chemotherapy for tumors in patients with CKD is much more complex than simply adjusting the dosage. If renal failure is irreversible, one must consider how many chemotherapy courses (even at a reduced dose) a patient can tolerate before their condition deteriorates sharply, rendering further antineoplastic therapy impossible. The antitumor effect is usually observed only after three to four courses of chemotherapy, except for some highly treatment-sensitive diseases. However, the risk of decompensation exists even after the first administration of an antitumor drug. If there is a possibility that the patient will not be able to complete all the necessary courses, pathogenetic antineoplastic therapy becomes meaningless.