Abstract: PO2163
AKI and Immune-Related Adverse Events (irAEs) in Patients with Genitourinary Cancers Receiving Immune Checkpoint Inhibitors (ICIs)
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
- Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States
- Street, Sarah E., Massachusetts General Hospital, Boston, Massachusetts, United States
- Lee, Meghan, Massachusetts General Hospital, Boston, Massachusetts, United States
- Strohbehn, Ian Austin, Massachusetts General Hospital, Boston, Massachusetts, United States
- Rusibamayila, Nifasha, Massachusetts General Hospital, Boston, Massachusetts, United States
- Chute, Donald F., Massachusetts General Hospital, Boston, Massachusetts, United States
- Reynolds, Kerry, Massachusetts General Hospital, Boston, Massachusetts, United States
- Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
Background
ICI use is associated with AKI. Patients with advanced genitourinary (GU) malignancies, including renal cell and bladder carcinoma, are at increased risk of AKI due to the high prevalence of chronic kidney disease (CKD) and frequent need for combination ICI and nephrotoxic platinum-based chemotherapy. We evaluated the incidence of AKI and irAEs in these patients.
Methods
Retrospective cohort of patients with GU-cancers receiving ICIs within a large healthcare network from 2011-2018. Cancer type, ICI class, comorbidities, baseline medications, and irAEs were determined using electronic records. AKI in the first 12 months after ICI initiation was the primary outcome. Multivariable models were used to evaluate for predictors of AKI.
Results
639 patients with GU-cancers were included. Average age was 66 years, 72% were male, 91% were white, 50% had CKD (eGFR<60 mL/min/1.73m2) and 51% had undergone full nephrectomy. 61% received PD1, 32% PDL1 and 7% combination PD1/CTLA4. 32% received prior platinum-based regimens or gemcitabine, and 8% received concurrent bevacizumab. 164 patients (26%) experienced AKI in the first 12 months. In a multivariable model, baseline coronary artery disease was predictive of AKI (p=0.02); prior nephrectomy, baseline CKD, and nephrotoxic chemotherapy exposure were not (Table). 185 (29%) experienced immune-related adverse events, most commonly thyroiditis (16%), gastrointestinal (7%), rash (4%), pneumonitis (4%), and hepatitis (4%).
Conclusion
AKI and irAEs are common in patients with GU-cancers receiving ICIs. Baseline CKD, prior nephrectomy nor nephrotoxic chemo use predict AKI after ICI indicating these factors should not exclude individuals from receiving treatment.