Abstract: FR-PO022

Nephrotoxicity of Immune Checkpoint Inhibitors: MD Anderson Cancer Center’s Experience

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Selamet, Umut, MD Anderson Cancer Center, Houston, Texas, United States
  • Ziaolhagh, Ali, UT Houston, Houston, Texas, United States
  • Lakhani, Laila S., UT Houston, Houston, Texas, United States
  • Lahoti, Amit, MD Anderson Cancer Center, Houston, Texas, United States
  • Workeneh, Biruh, MD Anderson Cancer Center, Houston, Texas, United States
  • Tchakarov, Amanda, UT Houston, Houston, Texas, United States
  • Glass, William F., UT Houston, Houston, Texas, United States
  • Abudayyeh, Ala, MD Anderson Cancer Center, Houston, Texas, United States
Background

Immune checkpoint (ICP) inhibitors, anti-CTLA-4 (Ipilimumab) and anti-PD-1 (Nivolumab and Pembrolizumab) have revolutionized treatment options for many types of cancers. Adverse events associated with ICP inhibitors are mainly due to uninhibited immune system causing autoimmune diseases. Literature on nephrotoxicity of these novel agents is limited. Acute tubulointerstitial nephritis (ATIN) is the most commonly described kidney injury secondary to ICP inhibitors. Few case reports also identified glomerulonephritis (GN) induced by ICP inhibitors.

Methods

We present 7 cases of biopsy proven nephrotoxicity during treatment with ICP inhibitors. Malignancies asscoiated with the cases were as following: Renal cell carcinoma (n=1), smoldering myeloma (n=2), melanoma (n=1), chondroma (n=1), bladder cancer (n=1) and lung cancer (n=1). Six out of 7 cases showed features of ATIN at kidney biopsy specimens. Several types of GNs were also observed: membranous GN, IgA nephropathy, and pauci immune GN. One patient had AA type amyloidosis. ICP inhibitors discontinued in all cases, and 5 cases were also treated with steroid. Steroid treatment resulted in either partial or full renal recovery in 4 out of 5 cases. Cases are summarized at Tables 1 and 2.

Conclusion

Early recognition of nephrotoxicity, utilization of kidney biopsy and steroid treatment for both ATIN and GN are the hallmarks of management of nephrotoxicities induced by ICP inhibitors.

Funding

  • Clinical Revenue Support