Bendamustine
Treanda · Alkylator
Tumor lysis-mediated AKI is the principal risk; TMA is rare.
PRETMALYTE
ModerateOpen →
Taxane
Cabazitaxel
Jevtana · CBZ
A second-line taxane whose rare AKI is generally gastrointestinal and hemodynamic in origin.
MildTaxane · approved 2010
Metastatic castration-resistant prostate cancer
Signature kidney injury
Prerenal / Hemodynamic AKI
Cabazitaxel has low direct nephrotoxicity; AKI is uncommon and, when it occurs, is usually mediated by gastrointestinal losses (diarrhea, occurring in a substantial minority), neutropenic sepsis, or hemodynamic instability rather than direct tubular toxicity. In real-world safety data, grade >=3 diarrhea and febrile neutropenia each occur in roughly 5% of patients. A drug-specific renal AKI rate is not well established.
Source: Castellano et al., Expert Opin Drug Saf 2014
Mechanism of kidney injury
No characteristic intrinsic renal toxin effect. Severe diarrhea and dehydration or neutropenic sepsis reduce renal perfusion and can cause prerenal and ischemic injury; otherwise the kidney is generally spared.
Clinical presentation
Usually preserved renal function; in the setting of diarrhea or sepsis, prerenal azotemia with bland sediment, a high BUN:creatinine ratio, and volume-depletion signs.
Onset
AKI follows intercurrent gastrointestinal or infectious complications during treatment cycles.
Reversibility
Reversible
Anticancer mechanism
Semisynthetic taxane with poor affinity for P-glycoprotein, retaining activity in docetaxel-resistant disease; stabilizes microtubules to block mitosis. Used in metastatic castration-resistant prostate cancer (mCRPC) after docetaxel.
Management
Volume repletion, control of diarrhea, and treatment of infection/neutropenic sepsis; prerenal AKI generally reverses with supportive care.
Risk factors
- Severe diarrhea and dehydration
- Neutropenic infection/sepsis (mitigated by G-CSF prophylaxis)
- Older age (>=75) and pre-existing renal impairment
- Higher dose (25 vs 20 mg/m2)
Prevention
- Antidiarrheal management and prompt oral/IV rehydration
- Primary G-CSF prophylaxis in high-risk patients to limit febrile neutropenia
- Maintain euvolemia and monitor renal function
Note · Rare AKI, mostly GI- and sepsis-mediated; not a characteristic direct nephrotoxin and non-renally cleared.
Clinical depth
Renal dose adjustment
Hepatically (CYP3A) metabolized with minimal renal excretion - no formal renal dose adjustment for mild-moderate impairment; use caution in severe impairment/ESKD given limited data. Reduce dose for hepatic impairment and with strong CYP3A inhibitors.
Dialyzability & ESKD dosing
Highly protein-bound and non-renally cleared; not dialyzable. No HD-timed dosing established.
Differential diagnosis
GI/sepsis-driven prerenal AKI (volume signs, bland urine) vs obstructive uropathy from prostate cancer vs concurrent nephrotoxin ATN. In mCRPC, also exclude post-renal obstruction.
Monitoring
- Stool frequency and hydration status each cycle
- CBC with differential (neutropenia) before each cycle
- Creatinine/electrolytes with diarrhea or infection
Key trials & series
- TROPIC (registrational survival benefit post-docetaxel)
- Castellano Expert Opin Drug Saf 2014 Spanish expanded-access safety cohort
Clinical pearls
- Cabazitaxel AKI is almost always downstream of diarrhea or neutropenic sepsis - treat the cause.
- Primary G-CSF prophylaxis cuts the febrile-neutropenia (and resulting hemodynamic AKI) risk.
- In a prostate-cancer patient with AKI, always exclude obstruction before blaming the taxane.
Where it strikes
Nephron segments
Vasculature / Endothelium
Glomerular & peritubular capillaries
Injury signatures
Prerenal / Hemodynamic AKI
Beyond the kidney
Class-level context for the major non-renal toxicities of taxanes.
Neurologic
Neuropathy, encephalopathy, ICANS, PRES
- Peripheral neuropathy (taxanes, vinca)
Hematologic
Cytopenias, thrombosis, TMA
- Myelosuppression
Immune / Infusion
CRS, infusion reactions, irAEs, anaphylaxis
- Hypersensitivity (taxane vehicles)
Evidence
4 peer-reviewed references. Citation metadata via PubMed / NLM.
LandmarkCabazitaxel for metastatic castration-resistant prostate cancer: safety data from the Spanish expanded access program.Castellano D et al. · Expert Opin Drug Saf 2014 · PMID 25001524Real-world safety cohort quantifying neutropenia and grade >=3 diarrhea, the drivers of hemodynamic/prerenal AKI.PMIDOnconephrology: Update in Anticancer Drug-Related Nephrotoxicity.García-Carro C et al. · Nephron 2022 · PMID 35717937Reviews taxane-class renal safety and the low direct nephrotoxicity of these agents.PMIDRe-visiting Hypersensitivity Reactions to Taxanes: A Comprehensive Review.Picard M et al. · Clin Rev Allergy Immunol 2015 · PMID 24740483Includes cabazitaxel among taxane hypersensitivity reactions relevant to infusion-related hemodynamic events.PMIDOnconephrology.Kala J et al. · Crit Care Clin 2021 · PMID 33752861Context for prerenal and sepsis-associated AKI mechanisms during chemotherapy.
Related agents
Other agents sharing the same signature kidney injury.