Clinical features associated with immune checkpoint inhibitor nephritis: a single-center clinical case series.
AKI
Checkpoint
Immunotherapy
Nephritis
Nivolumab
Pembrolizumab
Journal
Cancer immunology, immunotherapy : CII
ISSN: 1432-0851
Titre abrégé: Cancer Immunol Immunother
Pays: Germany
ID NLM: 8605732
Informations de publication
Date de publication:
06 Aug 2024
06 Aug 2024
Historique:
received:
17
01
2024
accepted:
05
07
2024
medline:
6
8
2024
pubmed:
6
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
Acute kidney injury (AKI) has been well described as a complication of immune checkpoint inhibitor therapy. We present a series of patients, the majority with lung adenocarcinoma, who developed AKI while actively receiving immune checkpoint inhibitors. This is a retrospectively analyzed clinical case series of six patients treated at City of Hope Comprehensive Cancer Center. Data were collected on gender, age, ethnicity, comorbidities, concomitant medications, type of malignancy, treatments, and renal function. All patients underwent renal biopsy for classification of the mechanism of AKI. Comprehensive genomic profiling (CGP) was performed on tumor tissue for all patients. Patterns of AKI included acute interstitial nephritis and acute tubular necrosis. Contributing factors included the use of concomitant medications known to contribute to AKI. All but two patients had full resolution of the AKI with the use of steroids. There were several mutations found on CGP that was notable including an Exon 20 insertion as well as multiple NF1 and TP53 mutations. There was high PD-L1 expression on tumor tissue noted in two out of six patients. In addition to AKI, a subset of patients had proteinuria with biopsies revealing corresponding glomerular lesions of minimal change disease and focal and segmental glomerulosclerosis. Our case series demonstrates that AKI from immune checkpoint inhibitors has a variable presentation that may require an individualized treatment approach. Further studies are needed to identify biomarkers that may help identify those at risk and guide the management of this condition.
Sections du résumé
BACKGROUND
BACKGROUND
Acute kidney injury (AKI) has been well described as a complication of immune checkpoint inhibitor therapy. We present a series of patients, the majority with lung adenocarcinoma, who developed AKI while actively receiving immune checkpoint inhibitors.
METHODS
METHODS
This is a retrospectively analyzed clinical case series of six patients treated at City of Hope Comprehensive Cancer Center. Data were collected on gender, age, ethnicity, comorbidities, concomitant medications, type of malignancy, treatments, and renal function. All patients underwent renal biopsy for classification of the mechanism of AKI. Comprehensive genomic profiling (CGP) was performed on tumor tissue for all patients.
RESULTS
RESULTS
Patterns of AKI included acute interstitial nephritis and acute tubular necrosis. Contributing factors included the use of concomitant medications known to contribute to AKI. All but two patients had full resolution of the AKI with the use of steroids. There were several mutations found on CGP that was notable including an Exon 20 insertion as well as multiple NF1 and TP53 mutations. There was high PD-L1 expression on tumor tissue noted in two out of six patients. In addition to AKI, a subset of patients had proteinuria with biopsies revealing corresponding glomerular lesions of minimal change disease and focal and segmental glomerulosclerosis.
CONCLUSIONS
CONCLUSIONS
Our case series demonstrates that AKI from immune checkpoint inhibitors has a variable presentation that may require an individualized treatment approach. Further studies are needed to identify biomarkers that may help identify those at risk and guide the management of this condition.
Identifiants
pubmed: 39105812
doi: 10.1007/s00262-024-03775-6
pii: 10.1007/s00262-024-03775-6
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Types de publication
Journal Article
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
200Informations de copyright
© 2024. The Author(s).
Références
Perazella MA, Sprangers B (2019) AKI in patients receiving immune checkpoint inhibitors. CJASN 14:1077–1079. https://doi.org/10.2215/CJN.02340219
doi: 10.2215/CJN.02340219
pubmed: 31048326
pmcid: 6625632
Herrmann SM, Perazella MA (2020) Immune checkpoint inhibitors and immune-related adverse renal events. Kidney Int Rep 5:1139–1148. https://doi.org/10.1016/j.ekir.2020.04.018
doi: 10.1016/j.ekir.2020.04.018
pubmed: 32775813
pmcid: 7403510
Kanbay M, Yildiz AB, Siriopol D, Vehbi S, Hasbal NB, Kesgin YE et al (2023) Immune checkpoints inhibitors and its link to acute kidney injury and renal prognosis. Int Urol Nephrol 55:1025–1032. https://doi.org/10.1007/s11255-022-03395-y
doi: 10.1007/s11255-022-03395-y
pubmed: 36282399
Seethapathy H, Zhao S, Chute DF, Zubiri L, Oppong Y, Strohbehn I et al (2019) The incidence, causes, and risk factors of acute kidney injury in patients receiving immune checkpoint inhibitors. CJASN 14:1692–1700. https://doi.org/10.2215/CJN.00990119
doi: 10.2215/CJN.00990119
pubmed: 31672794
pmcid: 6895474
Gupta S, Short SAP, Sise ME, Prosek JM, Madhavan SM, Soler MJ et al (2021) Acute kidney injury in patients treated with immune checkpoint inhibitors. J Immunother Cancer 9:e003467. https://doi.org/10.1136/jitc-2021-003467
doi: 10.1136/jitc-2021-003467
pubmed: 34625513
pmcid: 8496384
García-Carro C, Bolufer M, Bury R, Castañeda Z, Muñoz E, Felip E et al (2021) Acute kidney injury as a risk factor for mortality in oncological patients receiving checkpoint inhibitors. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfab034
doi: 10.1093/ndt/gfab034
pubmed: 31883322
Chen J-J, Lee T-H, Kuo G, Yen C-L, Lee C-C, Chang C-H et al (2024) All-cause and immune checkpoint inhibitor–associated acute kidney injury in immune checkpoint inhibitor users: a meta-analysis of occurrence rate, risk factors and mortality. Clin Kidney J 17(1):sfad292
doi: 10.1093/ckj/sfad292
pubmed: 38186874
Liu K, Qin Z, Ge Y, Bian A, Xu X, Wu B et al (2022) Acute kidney injury in advanced lung cancer patients treated with PD-1 inhibitors: a single center observational study. J Cancer Res Clin Oncol. https://doi.org/10.1007/s00432-022-04437-9
doi: 10.1007/s00432-022-04437-9
pubmed: 36585983
pmcid: 10349720
Bermejo S, Bolufer M, Riveiro-Barciela M, Soler MJ (2022) Immunotherapy and the spectrum of kidney disease: should we individualize the treatment? Front Med 9:906565. https://doi.org/10.3389/fmed.2022.906565
doi: 10.3389/fmed.2022.906565
Cortazar FB, Marrone KA, Troxell ML, Ralto KM, Hoenig MP, Brahmer JR et al (2016) Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int 90:638–647. https://doi.org/10.1016/j.kint.2016.04.008
doi: 10.1016/j.kint.2016.04.008
pubmed: 27282937
pmcid: 4983464
Kitchlu A, Jhaveri KD, Wadhwani S, Deshpande P, Harel Z, Kishibe T et al (2021) A systematic review of immune checkpoint inhibitor-associated glomerular disease. Kidney Int Rep 6:66–77. https://doi.org/10.1016/j.ekir.2020.10.002
doi: 10.1016/j.ekir.2020.10.002
pubmed: 33426386
RaoUllur A, Côté G, Pelletier K, Kitchlu A (2023) Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events. Clin Kidney J 16(6):sfad014
Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M et al (2021) Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. JCO 39:4073–4126. https://doi.org/10.1200/JCO.21.01440
doi: 10.1200/JCO.21.01440
Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S, Larkin J, Jordan K (2017) Management of toxicities from immunotherapy: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv119–iv142
doi: 10.1093/annonc/mdx225
pubmed: 28881921
Zhao D, Li H, Mambetsariev I, Chen C, Pharaon R, Fricke J et al (2021) Molecular and clinical features of hospital admissions in patients with thoracic malignancies on immune checkpoint inhibitors. Cancers 13:2653. https://doi.org/10.3390/cancers13112653
doi: 10.3390/cancers13112653
pubmed: 34071259
pmcid: 8198372
Sayer MR, Mambetsariev I, Lu K-H, Wong CW, Duche A, Beuttler R et al (2023) Predicting survival of NSCLC patients treated with immune checkpoint inhibitors: impact and timing of immune-related adverse events and prior tyrosine kinase inhibitor therapy. Front Oncol 13:1064169. https://doi.org/10.3389/fonc.2023.1064169
doi: 10.3389/fonc.2023.1064169
pubmed: 36860308
pmcid: 9968834
Lien Y-HH, Lai L-W (2011) Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis. Nat Rev Nephrol 7(2):85–95. https://doi.org/10.1038/nrneph.2010.171
doi: 10.1038/nrneph.2010.171
pubmed: 21151207
Wölffer M, Battke F, Schulze M, Feldhahn M, Flatz L, Martus P et al (2022) Biomarkers associated with immune-related adverse events under checkpoint inhibitors in metastatic melanoma. Cancers 14:302. https://doi.org/10.3390/cancers14020302
doi: 10.3390/cancers14020302
pubmed: 35053465
pmcid: 8773840
Les I, Martínez M, Pérez-Francisco I, Cabero M, Teijeira L, Arrazubi V et al (2023) Predictive biomarkers for checkpoint inhibitor immune-related adverse events. Cancers 15:1629. https://doi.org/10.3390/cancers15051629
doi: 10.3390/cancers15051629
pubmed: 36900420
pmcid: 10000735
Isik B, Alexander MP, Manohar S, Vaughan L, Kottschade L, Markovic S et al (2021) Biomarkers, clinical features, and rechallenge for immune checkpoint inhibitor renal immune-related adverse events. Kidney Int Rep 6:1022–1031. https://doi.org/10.1016/j.ekir.2021.01.013
doi: 10.1016/j.ekir.2021.01.013
pubmed: 33912752
pmcid: 8071627
Perazella MA (2020) Kidney biopsy should be performed to document the cause of immune checkpoint inhibitor-associated acute kidney injury: commentary. Kidney360 1(166):168
Rashidi A, Shah C, Sekulic M (2022) The role of kidney biopsy in immune checkpoint inhibitor-associated AKI. Kidney360 3(3):530–533
doi: 10.34067/KID.0000232022
pubmed: 35582173
pmcid: 9034825