Abstract: SA-PO177
Incidence of AKI in Melanoma Patients Treated with Immune 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
- Abudayyeh, Ala, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Lin, Yan Heather, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Lin, Jamie, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Mamlouk, Omar, University of Texas Health Science Center, Houston, Texas, United States
- Selamet, Umut, UCLA, Marina Del Rey, California, United States
- Abdelrahim, Maen, Houston Methodist Cancer Center, Houston, Texas, United States
Background
Immune checkpoint inhibition (ICI) had a major clinical success in clinical oncology. Immune related adverse events (irAEs) are well described toxicities. Unlike other common irAEs, the incidence of renal toxicity is reported 3.8% with varied definitions of AKI. In this study we sought to retrospectively review a single center 10 year experience of patients diagnosed with Melanoma and treated with CPI and evaluate incidence of AKI and overall survival.
Methods
We performed a retrospective chart review from 2008-2018 and extracted all patients treated with ICI. We identified 1691 unique melanoma patients and extracted all available creatinine. We have defined AKI based on KDIGO guidelines. 1st definition: as an absolute increase in serum creatinine of 0.3 mg/dl within 48 hours and 2nd as 50% relative increase in serum creatinine within 7 days. Time to first AKI was defined as time from treatment initiation to time of AKI. Cumulative incidence rate of AKI after initiation of ICIs were calculated in the presence of death as a competing risk. The effects of covariates on the cumulative incidence function of AKI were evaluated in the univariate setting using Gray’s test. Validity of the proportional cause-specific hazards and sub-distribution hazards assumptions were assessed using the proportionality test on time-varying covariates.
Results
Ipilimumab was the most commonly used ICI (27.63%). Incidence of AKI at median time of duration of treatment of 110 days using 1st definition was at 2.76% and using 2nd definition was at 3.25%. Patients older than 60 years of age (median) had a higher experiencing AKI than the younger patients. Compared to the patients treated with pembrolizumab, the patients treated with ipilimumab (HR3.68), ipilimumab /nivolumab (HR 5.271) Ipiliumab/Nivolumab/pembrolizumab (HR 4.284), ipiliumab/pembrolizumab (HR 7.285), nivolumab/pembrolizumab(HR 6.639) had significantly higher risk of experiencing AKI using both definitions.
Conclusion
With such a large population of melanoma patients treated with ICI we have the first accurate documentation of AKI in setting of ICI use and confirmation of incidence that has been reported. In addition, it’s an expansive look at predictors of AKI and the use of ipiliumuab and combinations of ICI more associated with AKI. Impact of AKI on survival is underway.
Funding
- Other NIH Support