Table 3.

Summary of known renal toxicities of antimyeloma agents (not Food and Drug Administration approved to treat myeloma) currently in clinical trials

Class/Drug Name	Published Toxicities in the Literature	Trial Stage	CKD Dosing	ESRD dosing
mTOR inhibitors
Temsirolimus	Proteinuria, FSGS, ATN	Phase 2 trials	No dose adjustment	Insufficient data
Everolimus	Proteinuria	Phase 1 trials	Individualized dosing on the basis of therapeutic drug monitoring	Insufficient data
Sirolimus	FSGS, TMA, ATN	Phase 1 trials	Individualized dosing on the basis of therapeutic drug monitoring	Insufficient data
BRAF inhibitors
Vemurafenib	AIN, ATN, subnephrotic proteinuria, hypokalemia, hyponatremia, fanconi syndrome	Phase 2 trials	No dose adjustment but also not well studied	Insufficient data
Dabrafenib	AKI, AIN, hypophosphatemia	Phase 2 trials	No dose adjustment	Insufficient data
HDAC inhibitors
Vorinostat	None reported	Phase 3 trials	No dose adjustment	Insufficient data
MEK inhibitors
Trametinib	Hypertension, hyponatremia, AKI	Phase 2 trials	No dose adjustment, for <30 cc/min – not studied	Insufficient data
Immune check point inhibitors
Nivolumab	AIN, hyponatremia	Phase 3 trials	No dose adjustment	Insufficient data
Pembrolizumab	AIN, hyponatremia	Phase 3 trials	No dose adjustment	Insufficient data
Anti–IL-6 agents
Siltuximab	Hyperkalemia, Hyperurecemia	Phase 2 trials	No dose adjustment if GFR>15 cc/min	Insufficient data
Anti-KIR agents
Lirilumab	AKI, hypophosphatemia	Phase 1 trials	No data available	No data available
Akt inhibitors
Perifosine	Hypophosphatemia	Phase 3 trials	No data available	No data available

mTOR, mammalian target of rapamycin; ATN, acute tubular necrosis; TMA, thrombotic microangiopathy; BRAF, v-Raf murine sarcoma viral oncogene homolog B; AIN, acute interstitial nephritis; HDAC, histone deactylase inhibitors; MEK, mitogen-activated protein kinase; KIR, killer Ig receptor; Akt, serine-threonine protein kinase B.