Abstract: PO1872
Immune-Checkpoint Inhibitor Use in Patients with ESKD
Session Information
- Cancer and Kidney Diseases: Nephrotoxins, RCC, and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada
- Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Sprangers, Ben, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Flanders, Belgium
- Yanagita, Motoko, Kyoto Daigaku, Kyoto, Japan
- Wanchoo, Rimda, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background
As use of immune check point inhibitor(ICI) therapy becomes increasingly widespread across different types of cancer, their use in patients receiving dialysis is likely to increase.
Methods
We performed a structured search of the MEDLINE and EMBASE databases from inception to February 2021. We sought to identify case reports, case series, observational studies and clinical trials which described the use of ICI therapy for cancer in patients receiving dialysis [either hemodialysis (HD) or peritoneal dialysis (PD)]. For each included study, we performed a standardized patient-level data abstraction using pre-specified parameters of interest: patient demographics, cancer diagnosis, ICI treatment characteristics, dialysis modality, immune-related adverse events (irAE), cancer outcomes and survival.
Results
136 citations for title and abstract screening were noted. Of these 33 met criteria for inclusion. 98 cases with patient-level data were included. Analysis of the reported cases in the literature demonstrates similar incidence of immune-related adverse events in patients with ESKD receiving dialysis as compared to the general population (49%). Grade 3 and 4 adverse events had been seen in fifteen patients (16%). Cancer remission (complete and partial) was seen in close to 30% of patients. Stable disease was seen in 28% and progression of disease in approximately 36% of patients. One-third of the patients died. Urothelial and RCC represented approximately half of all treated cancers, and accounted for approximately 50% of all deaths reported (Figure). Eighteen of the reported dialysis patients had prior kidney transplant. Of these, 11 (61%) initiated dialysis after ICI-related rejection of their kidney allograft.
Conclusion
ICI is well tolerated in ESKD patients. Additional data in the dialysis population with use of ICI, and involvement in prospective studies, is needed to better assess outcomes, particularly within specific cancer types.