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Abstract: FR-PO215

Real-World Incidence of Kidney Manifestations in Patients Treated With New Tyrosine Kinase Inhibitors

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Ratanasrimetha, Praveen, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Mamlouk, Omar, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Achi, Sai Santhoshini, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Long, James Patrick, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Page, Valda D., The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Mandayam, Sreedhar A., The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background

Imtainib was the first FDA approved Tyrosine kinase inhibitor (TKI) and since then there are more than 40 new approved TKI drugs. Multiple studies reported the incidence and clinical characteristics of TKI related nephrotoxicity; however, they were limited to the first approved TKI drugs. Currently, we are relying on FDA adverse reporting system (FARES) data for the newer agents, which is subject to bias. In this study we report our cancer center incidence of acute kidney injury (AKI) and proteinuria as the kidney manifestations associated with certain newer TKI agents.

Methods

This is a retrospective cohort study including patients who were treated with the following six most prescribed new tyrosine kinase inhibitors; regorafenib, axitinib, cabozantinib, erlotinib, ponatinib, and ibrutinib from January 2017 to October 2019 at MDA Cancer Center. We collected data related to patient baseline characteristics, concurrent nephrotoxic medication use, serum creatinine, and urine dipstick. We defined acute kidney injury and proteinuria as a rise in serum creatinine more than 50% above the baseline and a positive urine dipstick for protein, respectively, throughout the duration of TKI therapy and up to 45 days of stopping TKI.

Results

We identified 2063 subjects. Median age was 63 (SD=12.7) and the overall median duration of TKI therapy was ranging 28-67 days. Around half of the patients were on Ibrutinib. Proteinuria developed in approximately half of the patients (39-61% based on the TKI) and was more prevalent with Regorafenib (61%) vs. Axitinib (39%). 1.5 % of the patients develop AKI during the first 30 days of therapy and 11.1% thereafter. The incidence of AKI was ranging between 10-28% and was highest with Ponatinib (28%) vs. Irbutinib (10%). In univariate analysis, diabetes and proton pump inhibitors were associated with increased risk of developing proteinuria and AKI, respectively, during TKI therapy.

Conclusion

Our study provides a real-world data about the incidence of kidney related manifestation in patients treated with the newer generation of TKI agents. Proteinuria is the predominant kidney manifestation followed by AKI. Incidence of AKI is close to the first generation TKI with exception for ponatinib that had two to three times the risk of AKI.