Abstract: SA-PO233
Glomerular Pathology of Vascular Endothelial Growth Factor Inhibition: 12-Year Single-Center Experience
Session Information
- Onconephrology: Immunological Cross-Talk
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Charkviani, Mariam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Chowdhury, Raad Bin Zakir, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Mignano, Salvatore E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Buglioni, Alessia, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Alexander, Mariam P., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Herrmann, Sandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Vascular endothelial growth factor inhibitors (VEGF-I) are frequently used for cancer treatment. VEGF-I can cause proteinuria and acute kidney injury. Thrombotic microangiopathy (TMA) is common, but other glomerular pathologies are not well characterized. We aim to describe clinical characteristics and glomerular lesions associated with VEFG-I in a single center cohort.
Methods
We performed a retrospective chart review of patients treated with VGEF-I and underwent kidney biopsies from 2010 to 2022. Biopsy findings were reviewed by our pathologists.
Results
Nineteen biopsies were performed during 2010-2022 for kidney dysfunction in patients treated with VEGF-I. Eleven/19 had complete data. The median age was 62 (IQR 58-66) years, and the most common malignancy was renal cell carcinoma. TMA was found on 8/11 biopsies. Proteinuria was the most common reason for biopsy in patients with TMA. Three patients presented with other lesions besides TMA. One had anti-phospholipase A2 receptor-negative membranous nephropathy and both VEGF-I and pembrolizumab were stopped. She received prednisone with improvement in proteinuria. Another patient had known cryoglobulinemia with nephrotic range proteinuria exacerbated by VEGF-I peaking at 11g/day. Despite stopping VEGF-I and treating with prednisone+rituximab, he progressed to ESKD. Third patient had IgA nephropathy with diabetic changes, proteinuria progressed even after stopping VGEF-I (Table).
Conclusion
In this review of patients treated with VEGF-I undergoing kidney biopsy, we described the histological characteristics, clinical course, and outcomes. Our review adds information to the sparse literature on patients with renal dysfunction after receiving VEGF-I.
| Patient | Gender | Age | Kidney Biopsy Findings | Primary Malignancy | Cancer Treatment | Outcome |
| 1 | F | 55 | PLA2R Negative Membranous Nephropathy, Minimal IgA Nephropathy | Renal Cell Carcinoma | Axitinib + pembroluzimab | N/A |
| 2 | M | 59 | Cryoglobulinemia Type II | Renal Cell Carcinoma | Pazopanib | Progression of Cancer |
| 3 | M | 72 | IgA Nephropathy Diffuse DM glomerulosclerosis | Hepatocellular Carcinoma | Atezolizumab + Bevacizumab | Progression of Cancer |
| 4 | F | 51 | Acute to subacute TMA | Ovarian Cancer | Bemcitabine + bevacizumab | Deceased |
| 5 | F | 63 | Subacute TMA | Colon Cancer | Bevacizumab | Disease progression, deceased |
| 6 | F | 65 | TMA | Glioblastoma Multiforme | Bevacizumab | Progression of Cancer |
| 7 | F | 67 | TMA | Endometrial cancer | Bevacizumab | Progression of Cancer, Decreased |
| 8 | M | 62 | Subacute TMA | Gastrointestinal stromal tumor | Imatinib, Noilotinib, Regorafenib, Sunitinib, Pazopanib, Imatinib + Dasatinib | Progression of Cancer |
| 9 | F | 58 | TMA | Ovarian Cancer | Bevacizumab | Progression of Cancer |
| 10 | M | 60 | TMA | Renal Cell Carcinoma | Nivolumab + Ipilimumab, + Cabozantinib | N/A |
| 11 | M | 68 | TMA | Renal Cell Carcinoma | Axitinb + Pembrolizumab | Progression of Cancer |