Abstract: PO2159
Use of Immune Checkpoint Inhibitors in ESKD
Session Information
- Onco-Nephrology - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Wanchoo, Rimda, Northwell Health, Great Neck, New York, United States
- Ng, Jia Hwei, Northwell Health, Great Neck, New York, United States
- Hirsch, Jamie S., Northwell Health, Great Neck, New York, United States
- Parikh, Rushang, Northwell Health, Great Neck, New York, United States
- Khanin, Yuriy, Northwell Health, Great Neck, New York, United States
- Jhaveri, Kenar D., Northwell Health, Great Neck, New York, United States
Background
Use of immune checkpoint inhibitors(ICI) in ESKD patients is limited. We describe our single-center experience of ICI use in ESKD patients and summarize the current literature.
Methods
Using an analytics database, we identified all patients with a minimum of one ESKD diagnosis code who received ICI therapy at our health system. Charts were reviewed manually to confirm that patients were on HD or PD during the ICI therapy. Clinical details such as demographics, comorbidities, cancer type, immune-related adverse events (irAEs), cancer disease status, and patient survival were reviewed. Further literature search was performed for all published cases of ICI use in ESKD patients and was summarized as part of the methods.
Results
In total, 8 patients with ESKD were initiated on ICI. A variety of malignancies were identified. Four patients received pembrolizumab, two received nivolumab, one received both ipilumumab and nivolumab, and the last received PD-L1 inhibitor atezolizumab. All eight patients were receiving proton pump inhibitors. The mean duration on dialysis (dialysis vintage) prior to ICI therapy was 15.8 months (range: 3-60 months). Two patients had an immunotherapy-related adverse event. In both cases, the physicians discontinued the offending ICI agent and started the patients on systemic steroid therapy. Both patients subsequently suffered from cancer progression. The remaining patients tolerated the ICIs well, without significant complication or side effect. No dose adjustments were required. In regards to cancer status, the cancer did not progress in 3 patients but progressed in the remaining five. 4 patients died. Literature review revealed total of 26 patients mostly receiving HD (92%). Interestingly, 27% of these patients were on dialysis as a result of a rejected kidney transplant due to ICI therapy, and then continued to receive ICI. Over 80% of the patients had either partial or complete response to treatment. Aside from the kidney transplant rejection preceding dialysis, a minimal number of patients had a grade 2, 3, or 4 adverse immunotherapy related event (15%)
Conclusion
Based on our series and previously published literature review, the rate of adverse events appear similar to non-ESKD patients (15-25%). ESKD may not be a contraindication to the use of ICI therapy.