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Abstract: TH-PO158

Immune Checkpoint Inhibitor Use in a Patient with a History of Familial Anti-GBM Disease: A Clinical Dilemma

Session Information

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Ghamrawi, Ranine, Mayo Clinic, Rochester, Minnesota, United States
  • Manohar, Sandhya, Mayo Clinic, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic, Rochester, Minnesota, United States
Introduction

Immune checkpoint inhibitors (ICIs) have gained increasing use for the treatment of lung adenocarcinoma. Its utilization in patients with underlying autoimmune diseases is a challenge due to the fear of disease relapse or flare. Here, we present the case of a familial anti-GBM disease that received pembrolizumab for lung cancer.

Case Description

71 -year-old lady was evaluated 6 years ago for worsening kidney function. A kidney biopsy led to a diagnosis of anti GBM-disease. Circulating anti-GBM antibodies were positive. She was treated with steroids, cyclophosphamide and plasmapheresis. Interestingly, her family history was significant for familial anti-GBM disease affecting 2 of her siblings. Her creatinine peaked at 12.7 mg/dl and with treatment nadired at 1-1.2 mg/dl, with anti-GBM undetectable after therapy.
Three years later, she was diagnosed with left lung adenocarcinoma and underwent surgical resection, followed by external beam radiation and chemotherapy (carboplatin and paclitaxel). Unfortunately, her disease progressed and since she had positive Programmed Death-Ligand (PD L1) staining of her tumor cells; she was considered for starting on immunotherapy with pembrolizumab as a second line. She was evaluated by nephrology prior to initiation. Her baseline anti-GBM antibodies, ANCA antibodies and Anti-nuclear antibodies (ANA) were negative. Mutual decision with the patient was made to proceed with pembrolizumab with close monitoring of these tests and her serum creatinine. Seven months after treatment, her creatinine remains stable at 1.2-1.3 mg/dl with undetectable Anti-GBM, ANCA and ANA antibody titers.

Discussion

Checkpoint inhibitors are agents that unleash the immune system against cancer cells. Its use in patients with pre-existing autoimmune diseases pose a major clinical challenge. With cautious monitoring patients can use checkpoint inhibitors as a therapeutic option.