Abstract: FR-PO214
Renal Adverse Events Associated With the Immune Checkpoint Inhibitor Therapy: A Systematic Review and Bayesian Network Meta-Analysis of 96 Randomised Controlled Trials
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
- Trisal, Shehjar, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
- Low, Gary Kk, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
- Pathan, Faraz Khalid, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
- Gangadharan Komala, Muralikrishna, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
Background
Immune checkpoint inhibitors (ICI) have revolutionised cancer immunotherapy, improving survival in cancer patients. However, the blockade of immune regulatory sites, CTLA-4, PD-1, and PD-L1 is associated with a range of immune related adverse events (irAE) of which renal irAE occur infrequently and are not regularly reported.
Methods
The PRISMA guidelines were used to search for Randomised Control Trials (RCT) reporting severe adverse renal events across five electronic databases from inception to April 2022. This was supplemented with hand searching of major medical journals and the National Clinical Trials registry. A Bayesian network meta-analysis was performed using R version 4.1.0 R for the following outcomes: acute kidney injury (AKI), hypertension (HTN), glomerulonephritis, chronic kidney disease (CKD) and the composite of all acute adverse renal events (AARE) namely AKI, HTN and glomerulonephritis. Network meta-regression was performed to adjust for inconsistencies arising from malignancy subtype.
Results
96 RCTs reported severe grade adverse renal events. The risk of developing acute kidney injury is higher among patients who received PD-1 plus chemotherapy (OR 1.8 [95% CrI 1.3 to 2.4]) and PD-L1 plus chemotherapy (OR 1.90 [95% CrI 1.3 to 2.9]) when compared to standard chemotherapy and placebo (95 studies, 63, 793 participants). The risk of developing an AARE is higher among patients who received PD-1 plus chemotherapy (OR 1.7 [95% CrI 1.1 to 2.4]) and PD-L1 plus chemotherapy (OR 1.7 [95% CrI 1.1 to 2.6) when compared to standard chemotherapy and placebo (64,409 participants).
Conclusion
The combined regimen of PD-1 or PDL-1 + chemotherapy is associated with higher incidence of severe grade AKI and AARE. Prescription of combined therapy will warrant closer monitoring and implementation of preventive strategies/changes to the treatment regimen could be arranged early at the onset of adverse events.
Incidence of Acute Kidney Injury