Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practice

Geeta Sandhu^{1

2

3}, Josephine Adattini², Evangeline Armstrong Gordon², Niamh O'Neill², Corrinne Bagnis⁴, Alan V Boddy⁵, Pinkie Chambers⁶, Alex Flynn⁷, Brett Hamilton^{8

9

10}, Karim Ibrahim¹¹, David W Johnson^{12

13

14}, Christos Karapetis¹⁵, Aisling Kelly², Kimberley-Ann Kerr¹⁶, Ganessan Kichenadasse¹⁵, David S Kliman¹⁷, Craig Kurkard¹⁸, Winston Liauw^{19

20}, Catherine Lucas⁷, Andrew J Mallett^{21

22

23}, Jolanta Malyszko²⁴, Georgia McCaughan^{20

25

26}, Michael Michael^{27

28}, Sanja Mirkov^{29

30}, Emma Morris³¹, Carol A Pollock^{1

32}, Darren M Roberts^{20

33}, David J Routledge^{28

34}, Carla Scuderi^{30

35}, Julia Shingleton², Jake Shortt^{36

37}, Jim Siderov³⁸, Ben Sprangers^{39

40}, Brian N Stein^{41

42}, Amanda Tey⁴³, Kate Webber^{37

44}, Jenny Wichart⁴⁵, Rachel Wong^{46

47}, Robyn L Ward^{1

2}; ADDIKD Working Group

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² eviQ, Cancer Institute NSW, St Leonards, NSW, Australia.
³ Pharmacy Department, St Vincent's Hospital, Sydney, NSW, Australia.
⁴ Nephrology Department, APHP Sorbonne University, and GRIFON, Paris, France.
⁵ School of Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
⁶ University College London School of Pharmacy and University College London Hospital-University College London Centre for Medicines Optimisation Research and Education, London, United Kingdom.
⁷ Centre for Drug Repurposing, University of Newcastle, Newcastle, NSW, Australia.
⁸ Albury Wodonga Cancer Care, West Albury, NSW, Australia.
⁹ Northeast Health Wangaratta, Wangaratta, VIC, Australia.
¹⁰ Albury Wodonga Health, Albury, NSW, Australia.
¹¹ Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia.
¹² Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD, Australia.
¹³ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹⁴ Translational Research Institute, Brisbane, QLD, Australia.
¹⁵ Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia.
¹⁶ SA Health, Adelaide, SA, Australia.
¹⁷ Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁸ University of Newcastle, Newcastle, NSW, Australia.
¹⁹ Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia.
²⁰ School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
²¹ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia.
²² College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
²³ Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
²⁴ Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
²⁵ Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia.
²⁶ Garvan Institute of Medical Research, Sydney, NSW, Australia.
²⁷ Peter MacCallum Cancer Centre, Parkville, VIC, Australia.
²⁸ The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
²⁹ Pharmacy Department, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.
³⁰ School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.
³¹ Pharmacy Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
³² Kolling Institute Medical Research, Sydney, NSW, Australia.
³³ Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
³⁴ Clinical Haematology, Peter MacCallum Centre and Royal Melbourne Hospital, Parkville, VIC, Australia.
³⁵ Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
³⁶ Monash Haematology, Monash Health, Clayton, VIC, Australia.
³⁷ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
³⁸ Pharmacy Department, Austin Health, Melbourne, VIC, Australia.
³⁹ Biomedical Research Institute, Department of Immunology and Infection, UHasselt, Diepenbeek, Belgium.
⁴⁰ Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium.
⁴¹ ICON Cancer Centre, Adelaide, SA, Australia.
⁴² The University of Adelaide, Adelaide, SA, Australia.
⁴³ Pharmacy Department, Monash Health, Clayton, VIC, Australia.
⁴⁴ Department of Medical Oncology, Monash Health, Clayton, VIC, Australia.
⁴⁵ Alberta Health Services, Alberta, Canada.
⁴⁶ Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia.
⁴⁷ Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.

PMID: 40290844
PMCID: PMC12034076
DOI: 10.1016/j.eclinm.2025.103161

Review

Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practice

Geeta Sandhu et al. EClinicalMedicine. 2025.

. 2025 Mar 25:82:103161.

doi: 10.1016/j.eclinm.2025.103161. eCollection 2025 Apr.

Authors

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² eviQ, Cancer Institute NSW, St Leonards, NSW, Australia.
³ Pharmacy Department, St Vincent's Hospital, Sydney, NSW, Australia.
⁴ Nephrology Department, APHP Sorbonne University, and GRIFON, Paris, France.
⁵ School of Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
⁶ University College London School of Pharmacy and University College London Hospital-University College London Centre for Medicines Optimisation Research and Education, London, United Kingdom.
⁷ Centre for Drug Repurposing, University of Newcastle, Newcastle, NSW, Australia.
⁸ Albury Wodonga Cancer Care, West Albury, NSW, Australia.
⁹ Northeast Health Wangaratta, Wangaratta, VIC, Australia.
¹⁰ Albury Wodonga Health, Albury, NSW, Australia.
¹¹ Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia.
¹² Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD, Australia.
¹³ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹⁴ Translational Research Institute, Brisbane, QLD, Australia.
¹⁵ Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia.
¹⁶ SA Health, Adelaide, SA, Australia.
¹⁷ Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁸ University of Newcastle, Newcastle, NSW, Australia.
¹⁹ Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia.
²⁰ School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
²¹ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia.
²² College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
²³ Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
²⁴ Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
²⁵ Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia.
²⁶ Garvan Institute of Medical Research, Sydney, NSW, Australia.
²⁷ Peter MacCallum Cancer Centre, Parkville, VIC, Australia.
²⁸ The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
²⁹ Pharmacy Department, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.
³⁰ School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.
³¹ Pharmacy Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
³² Kolling Institute Medical Research, Sydney, NSW, Australia.
³³ Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
³⁴ Clinical Haematology, Peter MacCallum Centre and Royal Melbourne Hospital, Parkville, VIC, Australia.
³⁵ Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
³⁶ Monash Haematology, Monash Health, Clayton, VIC, Australia.
³⁷ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
³⁸ Pharmacy Department, Austin Health, Melbourne, VIC, Australia.
³⁹ Biomedical Research Institute, Department of Immunology and Infection, UHasselt, Diepenbeek, Belgium.
⁴⁰ Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium.
⁴¹ ICON Cancer Centre, Adelaide, SA, Australia.
⁴² The University of Adelaide, Adelaide, SA, Australia.
⁴³ Pharmacy Department, Monash Health, Clayton, VIC, Australia.
⁴⁴ Department of Medical Oncology, Monash Health, Clayton, VIC, Australia.
⁴⁵ Alberta Health Services, Alberta, Canada.
⁴⁶ Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia.
⁴⁷ Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.

PMID: 40290844
PMCID: PMC12034076
DOI: 10.1016/j.eclinm.2025.103161

Abstract

Part 2 of the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) offers drug-specific consensus recommendations based on both evidence and practical experience. These recommendations build upon the kidney function assessment and classification guidelines established in Part 1 of ADDIKD. Here we illustrate how dosing recommendations differ between ADDIKD and existing guidance for four commonly used drugs: methotrexate, cisplatin, carboplatin and nivolumab. We then describe how the recommendations can be distilled into practice points for methotrexate and cisplatin. While ADDIKD is a significant improvement from previous guidelines, adoption of this new guideline requires further endorsement from key external stakeholders, 'change championing' by clinicians locally and encouraging its integration into existing reference sources, clinical trial protocols and electronic prescribing systems.

Funding: Development of the ADDIKD guideline is funded by the NSW Government as part of the Cancer Institute NSW and received no funding from external commercial sources.

Keywords: Chemotherapy; Drug dosing; Haematology; Kidney dysfunction; Oncology; Pharmacokinetics; Renal.

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Conflict of interest statement

AJM reports a relationship with National Health and Medical Research Council that includes: funding grants. AJM reports a relationship with Australian Government Medical Research Future Fund that includes: funding grants. AJM reports a relationship with Queensland Government that includes: funding grants. AJM reports a relationship with Townsville Hospital and Health Service that includes: funding grants. AJM reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: travel reimbursement. AJM reports a relationship with GSK that includes: travel reimbursement. AJM reports a relationship with Australia and New Zealand Society of Nephrology that includes: board membership. JS reports a relationship with Roche that includes: speaking and lecture fees. JS reports a relationship with Amgen Inc that includes: speaking and lecture fees. JS reports a relationship with AbbVie Inc that includes: speaking and lecture fees. JS a relationship with Pfizer Inc that includes: speaking and lecture fees. JS reports a relationship with Mundipharma International Limited that includes: speaking and lecture fees. JS reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. JS reports a relationship with Baxter Health that includes: speaking and lecture fees. JS reports a relationship with Becton Dickinson and Company that includes: speaking and lecture fees. JS reports a relationship with Juniper Pharmaceuticals Inc that includes: board membership. JS reports a relationship with Antengene Corporation Limited that includes: board membership. DWJ reports a relationship with Baxter Health that includes: speaking and lecture fees. JSho reports a relationship with Astex Pharmaceuticals US Corporate and Development Headquarters that includes: funding grants. JSho reports a relationship with Astellas Pharma Inc that includes: consulting or advisory. JSho reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: consulting or advisory. JSho reports a relationship with Novartis Pharmaceuticals Corporation that includes: consulting or advisory and speaking and lecture fees. JSho reports a relationship with Pfizer Inc that includes: consulting or advisory. JSho reports a relationship with Mundipharma International Limited that includes: speaking and lecture fees. JSho reports a relationship with Bristol Myers Squibb Co that includes: board membership. JSho reports a relationship with Victoria Cancer Council that includes: board membership. JSho reports a relationship with Australian Leukaemia and Lymphoma Group that includes: board membership. GM reports a relationship with Janssen that includes: speaking and lecture fees, travel reimbursement. GM reports a relationship with Pfizer that includes: speaking and lecture fees. BS reports a relationship with Omeros Corporation that includes: consulting or advisory. BS reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees and travel reimbursement. BS reports a relationship with Vifor Pharma Switzerland SA that includes: speaking and lecture fees. BS reports a relationship with Janssen Pharmaceuticals Inc that includes: speaking and lecture fees. BS reports a relationship with Boehringer Ingelheim Corp USA that includes: board membership and speaking and lecture fees. BS reports a relationship with MorphoSys US Inc that includes: board membership. GK reports a relationship with Cancer Council SA that includes: board membership. SM reports a relationship with AdPha that includes: board membership. EM reports a relationship with Novartis that includes: speaking and lecture fees. EM reports a relationship with Lilly that includes: travel reimbursement. PC reports a relationship with Pfizer that includes: funding grants. PC reports a relationship with Gilead Sciences Inc that includes: funding grants, speaking and lecture fees, and travel reimbursement. RLW reports a relationship with NSW Cancer Institute that includes: board membership. RLW reports a relationship with the Pharmaceutical Benefits Advisory Committee, Commonwealth of Australia that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Methotrexate dosing practice points from ADDIKD.

**Fig. 2**
Cisplatin dosing practice points from ADDIKD.

See this image and copyright information in PMC

References

1. Sandhu G., Adattini J., Gordon E.A., O'Neill N., On behalf of the ADDIKD Guideline Working Group International consensus guideline on anticancer drug dosing in kidney dysfunction. 2022. https://www.eviq.org.au/clinical-resources/addikd-guideline/4174-antican...
1. Sandhu G., Adattini J., Gordon E.A., et al. Aligning kidney function assessment in patients with cancer to global practices in internal medicine. eClinicalMedicine. 2025;82
1. Sandhu G., Gordon E.A., Adattini J., et al. A methodology for determining dosing recommendations for anticancer drugs in patients with reduced kidney function. eClinicalMedicine. 2025;82
1. Ashley C., Dunleavy A. The renal drug database. https://renaldrugdatabase.com/
1. Therapeutic goods administration. https://www.ebs.tga.gov.au

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Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practice

Affiliations

Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practice

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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