How do you manage maintenance therapy in metastatic NSCLC, adenocarcinoma with good response to initial chemo (carboplatin, pemetrexed, pembrolizumab) with borderline renal function that has worsened during initial treatment?   

This is a difficult situation as it may not be possible to discern if creatinine elevation is related to pemetrexed versus immune checkpoint inhibitor (ICI)-nephritis; therefore, nephrology assessment would be crucial.I assume the question is regarding patients with significant renal impairment (i.e...

I very much agree with Dr. @Umit Tapan's answer here.   This is a common and vexing problem for the clinician- when facing renal toxicity- a real concern with short and long-term health consequences but in a setting that our patient also needs life-prolonging systemic therapy. Which d...