Abstract: FR-PO181
The Use of Rituximab in Treatment of Immune Checkpoint Inhibitor Induced Glomerulonephritis
Session Information
- Onconephrology: Clinical and Research Advances - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Achi, Sai Santhoshini, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
- Tchakarov, Amanda, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
- Abdelrahim, Maen, Houston Methodist Hospital, Houston, Texas, United States
- Wang, Daniel Y., Baylor College of Medicine, Houston, Texas, United States
- Morris, Van, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Introduction
Immune checkpoint inhibitors (ICI) have been shown to induce and exacerbate autoimmune side effects in patients with underlying autoimmune diseases. Immune adverse events of the kidney have been reported in 2-5% cases: majority of which are acute interstitial nephritis and less than 1% are glomerular diseases. Though glomerular disease is rare, it adds further complexity to cancer patients' care. We describe two cases of glomerulonephritis (GN) successfully treated with rituximab and continued ICI with cancer and renal response.
Case Description
A 64 year old male with mesothelioma and treated with nivolumab, developed nephrotic range proteinuria after two cycles, and biopsy confirmation of membranous nephropathy with positive antibody to PLA2R.The patient was started on rituximab course, achieved complete renal response, and continued nivolumab for 3 years. The PET/CT imaging continues to depict complete metabolic response and serum Anti-PLA2R negative.
The second patient is a 71 year old female with squamous cell cancer of the anal canal who did not respond to cisplatin and 5-FU and was started on nivolumab. After the fourth cycle, she developed nephrotic range proteinuria. Biopsy confirmed minimal change disease, she was treated with a course of steroids and rituximab. She achieved complete remission of her proteinuria and had an excellent cancer response with continued ICI treatment.
Discussion
We present two unique cases of membranous nephropathy and minimal change disease in cancer patients after ICI exposure successfully treated and re-challenged on ICI with continued renal and tumor response. Based on a recent systematic review of ICI induced GN, the most frequent GN reported was pauci-immune and renal vasculitis (27%), podocytopathies (24%), and complement 3 GN (C3GN; 11%).There are no current guidelines on treatment of ICI induced GN. Based on our experience in vasculitis and current glomerulopathies,by targeting the B cells implicated in the autoimmune induction,rituximab offers an attractive treatment option and patients can continue ICI and improve overall survival.