Abstract: SA-PO179
A Single-Institution Study of Renal Outcomes in Patients Receiving Checkpoint Inhibitors
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Shah, Savan, University of South Florida, Tampa, Florida, United States
- Kerr, Daniel A., University of South Florida, Tampa, Florida, United States
- Mushtaq, Sarah, University of South Florida, Tampa, Florida, United States
- Mirza, Abu-Sayeef, University of South Florida, Tampa, Florida, United States
- Hassanein, Hatem, University of South Florida, Tampa, Florida, United States
- Shirley, Kayla, University of South Florida, Tampa, Florida, United States
- Lee, Jung-hoon, University of South Florida, Tampa, Florida, United States
- Bassil, Claude, University of South Florida, Tampa, Florida, United States
Background
Checkpoint inhibitors (CPI) are becoming more widely used for various malignancies. The reported incidence of renal toxicities has varied, with a lower incidence reported in clinical trials but significantly higher in follow-up retrospective cohorts. Here, we present a single-institution retrospective study monitoring renal function in patients receiving CPI treatment.
Methods
An IRB-approved retrospective analysis was performed using patients seen at Moffitt Cancer Center between 1/1/2015 and 1/1/2016 who were receiving CPI therapy (ipilimumab, nivolumab, pembrolizumab or any combination). Selected patients had up to 12 months follow-up including laboratory analysis of renal function. If available, serum electrolytes and urine studies were also collected. Primary endpoint was acute kidney injury (AKI), defined as increase in serum creatinine by > 0.3 mg/dL or ≥ 50% from baseline.
Results
206 patients were selected with most common diagnoses of melanoma (81%) or NSCLC (12%). Most patients (79%) also had stage 4 disease. There were 19 patients who had AKI, with a median age of 73 vs 68 in the non-AKI group (p = 0.057). There was no difference in HTN, DM, CKD stage, baseline creatinine, or baseline blood pressure between groups. There was no correlation between AKI and specific CPI therapy or combined CPI therapy. In the AKI group, there was a higher incidence of concomitant antihistamines (42% vs 15%, p = 0.003) and diuretics (37% vs 17%, p = 0.03). In the AKI group, 10 discontinued all CPI therapy due to disease status (progression or surveillance). 4 patients had AKI associated with autoimmune toxicity (2 colitis, 1 pancreatitis, 1 autoimmune nephritis) that resolved with steroids and stopping/changing CPI. 6 patients continued therapy without interruption, 4 had resolution of AKI. 5 patients had increasing SBP (>20 mmHg) at the time of AKI.
Conclusion
In our cohort, CPI therapy was well-tolerated from the standpoint of renal function. Of the 19 (9%) patients who experienced AKI, only 4 patients (1.9%) had AKI associated with autoimmune-related toxicity. Our data suggest the concomitant use of other potentially nephrotoxic drugs (e.g., antihistamines, diuretics) may be associated with increased risk of AKI.