Abstract: FR-OR019
Renal Immune Related Adverse Events in Patients Treated with PD-1 Inhibitors: An Emerging Complication of Immunotherapy
Session Information
- AKI: Can We Improve Outcomes?
October 26, 2018 | Location: 6A, San Diego Convention Center
Abstract Time: 06:06 PM - 06:18 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
Inhibition of programmed cell death protein 1 (PD-1) immune checkpoint pathway activates patient’s immune system, which is responsible for anti-tumor effect but may cause unwanted immune-related adverse events (IrAE) including renal effects.
Methods
Retrospective review of cases of acute kidney injury (AKI) or nephrotic syndrome while on treatment with PD-1 inhibitors seen at MSKCC between 2012 and 2018. Patients concurrently treated with another checkpoint therapy were excluded.
Results
Thirty-one patients were identified and twenty-three met inclusion criteria. Eight were male and the average age was 61.7 years. Fourteen patients had a biopsy while nine were treated empirically. The mean number of immunotherapy cycles prior to onset of AKI was 5.08 (1-14). In the biopsy group (Table 1), thirteen patients had AIN and one had membranous glomerulonephropathy (MGN). All had either full or partial recovery of renal function. Two patients were re-challenged with PD-1 inhibitors and tolerated 2 and 5 cycles respectively accompanied by low dose steroid therapy. One patient was re-challenged without corticosteroids and AKI recurred after 10 cycles. One patient with biopsy proven AIN received 5 additional cycles without further worsening of renal function. The patient with MGN developed a relapse after re-challenge with checkpoint inhibitor but tolerated additional 5 cycles with supportive care.
Conclusion
Most patients with renal IrAE developed AIN and all recovered kidney function. These patients can be re-challenged with PD-1 inhibitors if clinically indicated with concomitant steroid therapy support.
| Patient | Age (years) | Gender (M/F) | Baseline SCr* (mg/dL) | Peak SCr (mg/dL) | Urinalysis findings | Check-point number of cycles | Nephritis treatment | Re-challenge with check point | Last SCr (mg/dl) | Biopsy Findings |
| 1 | 71 | F | 0.8 | 6.5 | Pyuria Eosinophil 2% | 3 | Steroid taper | No | 1.3 | AIN** |
| 2 | 71 | F | 1.3 | 2.1 | Albumin 100 Pyuria 5-10 RBC/HPF | 5 | None | No | 1.4 | AIN |
| 3 | 83 | F | 0.9 | 1.9 | Pyuria 9 RBC/HPF | 8 | None | No | 1.0 | AIN |
| 4 | 62 | F | 0.6 | 1.3 | Pyuria 5 RBC/HPF | 3 | Steroid taper and maintenance | Yes (2 doses) | 1.0 | AIN |
| 5 | 69 | M | 1.1 | 1.7 | 6-10 WBC/HPF | 5 | Steroid taperx2 | Yes (5 doses) | 1.5 | AIN |
| 6 | 73 | F | 0.8 | 5.1 | Albumin 100 | 1 | Steroid taper | No | 1.1 | AIN |
| 7 | 58 | F | 1.2 | 1.6 | Bland | 8 | Steroid taper | No | 1.0 | AIN |
| 8 | 75 | M | 1.1 | 1.0 | Albumin >1000 | 6 | Steroid taper | Yes-partial remission and recurrence | 0.6 | MGN† PLA2R Neg |
| 9 | 73 | M | 1.0 | 3.3 | Bland | 10 | Steroid taper | No | 1.5 | AIN |
| 10 | 69 | M | 1.3 | 3.9 | Albumin trace | 2 | Steroid taper | No | 1.4 | AIN |
| 11 | 74 | F | 0.7 | 4.5 | Albumin trace | 7 | Steroid taper | No | 1.2 | AIN |
| 12 | 50 | F | 0.6 | 1.5 | Bland | 5 | Steroid taper | No | 1.0 | AIN |
| 13 | 67 | F | 0.7 | 1.9 | trace hematuria 9RBC/HPF | 4 | Steroid taper | No | 1.2 | AIN |
| 14 | 45 | M | 0.8 | 1.5 | Bland | 3 | None | Yes (5 doses) | 1.0 | AIN |
Funding
- Other NIH Support