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Abstract: FR-PO617

Immune Checkpoint Inhibitors as Potential Triggers for ANCA Vasculitis

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Aqeel, Faten Faisal, Johns Hopkins University, Baltimore, Maryland, United States
  • Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
Introduction

Immune checkpoint inhibitors (ICIs) have made a tremendous impact on the survival of patients with certain cancers. However, Immune-related adverse events (IrAEs) have been implicated in such therapies. Little is known about the relationship between ICIs and ANCA-associated vasculitis (AAV). We report a case of de-novo MPO ANCA positive AAV and a case of relapsing PR3 ANCA positive AAV following treatment with ICI. This observational report highlights two cases of AAV patients occurring after ICI therapy. We looked at the onset of AAV, type of ANCA, kidney biopsy results, and clinical outcomes.

Case Description

One patient developed de-novo MPO ANCA positive AAV 11 months after treatment with ICI, pembrolizumab. The second patient with relapsing PR3 ANCA positive AAV developed yet another relapse after 1 month of ICI. Both patients presented with kidney injury, proteinuria, and hematuria. Remission was achieved after rituximab and glucocorticoids treatment. (Table 1)

Discussion

ICIs, specifically PD-1 inhibitors could cause de-novo AAV or trigger a relapse of AAV. Close monitoring of disease relapse is critical in AAV patients undergoing ICI therapy.

Patient characteristics, type of cancer, ICI treatment, onset of vasculitis, ANCA type, and treatment
IDAge,
year
Race Sex Type of cancer ICI Existing AAV before ICI ANCA type Timing of AAV after initiation of ICI (months)Presenting findingsTreatment Nadir sCr (mg/dL)AAV status at last follow up
165CMSquamous cell carcinoma of left palatine tonsil PembrolizumabNMPO11AKI (sCr 7.20) hematuria, proteinuria, foot drop RTX + GC1.5Remission
267C F Squamous cell cancer of the lung PembrolizumabYPR31AKI (sCr 2.2), hematuria, proteinuria RTX + GC1.8 (baseline sCr)Remission

AAV: ANCA associated vasculitis, ANCA: anti-neutrophil cytoplasmic antibody, ICI: Immune checkpoint inhibitor, F: female, M: male, C: Caucasian, PR3: proteinase-3, MPO: myeloperoxidase, GC: glucocorticosteroids, RTX: rituximab, AKI: acute kidney injury, sCr: serum creatinine, N: no, Y: yes