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Kidney Week

Abstract: PO2166

Statin Use, Renal Cell Carcinoma, and Combination Immunotherapy Increase Risk of Checkpoint Inhibitor-Induced Nephritis: A Single-Center Database Study

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

  • Prosek, Jason, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Owen, Dwight, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Husain, Marium, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Wei, Lai, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Lopez, Gabrielle Antoinette, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Zhao, Songzhu, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

Immune checkpoint inhibitors (ICI) are associated with improved cancer outcomes, however immune related adverse events (irAE) develop and are poorly understood. Renal irAE (RirAE) are less common but may jeopardize effective cancer therapy, and no reliable risk factors for RirAE have been identified. Concomitant medications have been shown to play a role in response to ICI but the impact on toxicity is unknown. We report risk factors and clinical outcomes of patients who develop RirAE.

Methods

We queried a patient database with advanced cancer treated with ICI between 2010 and 2017 at Ohio State Univ for pts who developed AKI (defined as a doubling of creatinine after initiation of ICI). irAEs were reviewed by nephrologist and oncologist. Overall survival (OS) was calculated from date of initiation of ICI to death from any cause or date of last follow-up. Associations between irAE incidence and categorical outcomes were studied using chi-square or Fisher’s exact test. The Wilcoxon test was used for continuous outcomes. Survival outcomes were studied using log-rank test or cox regression model.

Results

Of 1,091 pts treated with ICI, 160 (14.7%) developed AKI of any cause and 30 (2.74%) developed RirAE. PPI use (p=0.032), renal cell carcinoma (RCC) diagnosis (p=0.009) and line of therapy (p=0.033) were all associated with development of AKI, and RCC, BMI, and line of therapy remained significant in multivariate analysis[OD1]. Overall survival (OS) was 12.2 months in absence of AKI vs 10.7 months with AKI (p=0.0125). Statin use (p=0.007) and RCC diagnosis (p=0.012) were significantly associated with RirAE with a trend to higher rates in combination immunotherapy (p=0.064). These three variables were also significant in multivariate analysis. OS was not different in the RirAE group (10.8 months) vs no RirAE group (11.8 months).

Conclusion

Patients undergoing ICI therapy can develop AKI as well as RirAE. However, outcomes are worse for AKI. Survival for pts who develop RirAE does not appear to differ from patients without RirAE. AKI and RirAE share an independent risk factor in RCC. However, statin use and combination ICI therapy appear to be unique risk factors for RirAE. Further studies are needed to verify the finding regarding statin use, a drug with widespread use.