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Kidney Week

Abstract: SA-PO520

Rate of AKI with Epithelial Growth Factor Tyrosine Kinase Inhibitors

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Scott, Michaela, New York Medical College, New York, New York, United States
Background

Epithelial growth factor receptor (EGFR) mutations are found in several tumors, especially non-small cell lung cancer (NSCLC), occurring in 10-15% of NSCLC in Europe and 30-40% in Asia. Renal dysfunction is rare with EGFR TKIs. In phase III clinical trials, one patient on erlotinib had any grade renal failure and 1.5% of patients treated with gefitinib had an elevated creatinine (Cr). EGFR is expressed throughout the mammalian kidney and EGF and EGFR ligands are involved in renal development. In animal models, EGFR activation, and reductions in EGFR or EGFR TKI activity are associated with both benefit and harm to renal function, depending on the model of renal injury.
The purpose of this this study is to determine the rate of acute kidney injury (AKI) with the use of EGFR TKIs at a single center.

Methods

Retrospective data was collected on all adult patients at our institution who received any EGFR TKI from 1/1/2014-12/31/2016. Demographic data, baseline Cr (Cr within 30 days prior to treatment) and peak Cr after each treatment cycle were collected. AKI was defined as an increase in Cr >1.5x baseline. Incomplete recovery of renal function was defined as a last Cr >25% of baseline. All statistical analyses was conducted using R version 3.4.4. A p-value of <0.05 was considered statistically significant.

Results

Analyses was performed on 1831 observations in 503 patients. Of 503 patients, AKI occurred in 121 (24%). Of these, 103(85%) had incomplete recovery of renal function. The average time from baseline to last Cr was 314.8 days. Overall, 85% of patients were treated for lung cancer. AKI occured in 26% of lung cancer patients and 92% of all patients with AKI had underlying lung cancer (p=0.001). Overall, 385 (77%) patients were treated with erlotinib. AKI occured in 28% of patients treated with erlotinib and 89% of all patients with AKI had received erlotinib (p=0.002). Overall, the group was largely white (67%), non-Hispanic (91%) and female (70%), with no significant differences between those with and without AKI.

Conclusion

The rate of AKI with any EGFR TKI was 24%. On follow up, 85% of patients never returned to within 25% of their baseline Cr. AKI rates were significantly higher in lung cancer patients and with erlotinib use. Retrospective data with it attendant limitations cannot assign causality or define mechanisms. This relationship needs further examination.