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Abstract: PO2160

AKI as a Risk Factor for Mortality in Oncological Patients Receiving Immunotherapy

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

  • García-Carro, Clara, Hospital Vall d'Hebron, Nephrology Department, Barcelona, Spain
  • Bolufer, Mónica, Hospital Vall d'Hebron, Nephrology Department, Barcelona, Spain
  • Bury, Roxana, Hospital Vall d'Hebron, Nephrology Department, Barcelona, Spain
  • Muñoz, Eva, Hospital Vall d'Hebron, Oncology Department, Barcelona, Spain
  • Felip, Enriqueta, Hospital Vall d'Hebron, Oncology Department, Barcelona, Spain
  • Gabaldon, Alejandra, Hospital Vall d'Hebron, Pathology Department, Barcelona, Spain
  • Carreras, Maria Josep, Hospital Vall d'Hebron, Pharmacy Department, Barcelona, Spain
  • Serón, Daniel, Hospital Vall d'Hebron, Nephrology Department, Barcelona, Spain
  • Soler, Maria Jose, Hospital Vall d'Hebron, Nephrology Department, Barcelona, Spain
Background

Checkpoint inhibitors (CPI) are used to treat cancer by promoting immune-mediated elimination of tumor. CPI–associated AKI (CPI-AKI) is an adverse effect and its incidence is 13-29%. The effect of CPI-AKI on patient survival is unknown. Our aim is to evaluate if CPI-AKI is a risk factor for mortality in patients with cancer under immunotherapy.

Methods

We evaluated data of all patients under CPI at our centre between March 2018-May 2019 and followed-up until April 2020. We divided them into 2 groups according the development of CPI-AKI. Kaplan-Meier and Cox survival analysis comparing patients who developed CPI-AKI with those who did not were performed.

Results

821 patients received CPI during the study period. Mean age was 62.03 years and 59.2% men. Malignancies: lung 30.3%, urogenital 20.5%, melanoma 10.8%,others 38.4%. 54.34% patients received antiPD1, 28% antiPDL1, 1.6% antiCTLA4, 4.4% other drug, 11.7% two CPI. Mean baseline creatinine was 0.85±0.30 mg/dL. 125 patients (15.2%) developed CPI-AKI. 790 patients completed follow up and were included in the survival analysis, including all with CPI-AKI. Mean time of follow up 13.20months. 50.8% patients had died at the end of follow up, mean time after starting CPI 8.60 months. There were no differences in age/gender or basal creatinine between patients who died and those who survived. In patients who developed CPI-AKI, mortality was 70.40% vs 47.27% as compared with non-CPI-AKI (p<0.0001). Cox survival analysis including age/gender, malignance and type of CPI identified CPI-AKI as a risk factor for mortality (HR 1.597, 95%CI 1.258-2.028, p<0.001), as well as malignance (melanoma HR 1.897, 95% CI 1.290-2.793, lung HR 1.272, 95% CI 1.010-1.602 and urogenital HR 1.543, 95% CI 1.178-2.041, p=0.001) and CPI (PD1 HR 2.160, 95% CI 1.458-3.205, PDL1 HR 1.887, 95% CI 1.253-2.84 and 2 drugs HR 2.049, 95% CI 1.279-3.279,p=0.005).

Conclusion

In a study including more than 800 patients with advanced cancer receiving immunotherapy, CPI-AKI incidence was 15.2%. More than 50% of patients died during a mean follow up of 13 months. CPI-AKI development was a risk factor for mortality in our series. As far as we know, this is the first time that the association between AKI and mortality in patients receiving immunotherapy is described.