Kidney Week

Abstract: TH-PO0176

Multidisciplinary Approach to Immune-Related Adverse Events: A Comprehensive Cancer Centre Experience

Session Information

• Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Ribeiro, Ligia Catarina, Unidade Local de Saude de Castelo Branco EPE, Castelo Branco, Castelo Branco District, Portugal

Ligia Catarina Ribeiro, MD

• Inácio, António da Silva, Unidade Local de Saude da Arrabida, Setúbal Municipality, Setubal, Portugal

António da Silva Inácio, MD

• Russo, Diana, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Diana Russo, MD, MSc

• Chuva, Teresa, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Teresa Chuva, MD

• Oliveira, Vanessa, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Vanessa Oliveira, MD

• Gonçalves, Inês, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Inês Gonçalves, MD

• Silva, Helena Margarida Correia Ferreira, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Helena Margarida Correia Ferreira Silva, MD

• Libanio, Diogo, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Diogo Libanio, MD, PhD

• Videira Santos, Fábio, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Fábio Videira Santos, MD

• Oliveira, Joana, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Joana Oliveira, DrMed

• Barreto, Joao Pedro, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Joao Pedro Barreto, MD

• Ferreira, Augusto Carmo, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Augusto Carmo Ferreira, MD

• Sousa, Jose P, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Jose P Sousa, MD

• Oliveira, Raquel Ortigao, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Raquel Ortigao Oliveira, MD

• Costa, José Maximino, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

José Maximino Costa, MD

• Rosinha, Alina Oliveir, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal

Alina Oliveir Rosinha, MD

Background

Immune checkpoint inhibitors (ICI) revolutionized oncology, but immune-related adverse events (irAEs) became a challenge. Multidisciplinary Immune Toxicity Tumor Board (Mult’iTOX) at IPO Porto offers multidisciplinary approach to complex irAEs.

Methods

Retrospective analysis of Mult’iTOX-approached cases from 06/2023 to 04/2025.

Results

A total of 77 complex patients were assessed. 55.8% male, median age 60 (50-71). Skin cancer was the most common (46.8%). 53.2% were on Pembrolizumab. 55.8% were on palliative ICI. 59 cases had histologic confirmation.
Referrals were mostly due to gastrointestinal (GI) irAEs (40%). Grade 3 IrAEs (CTCAE) were mainly reported (n=42). Multiple irAEs occurred in 32.8%.
Steroids were the core treatment (mean dose 1.20±0.6mg/kg/day, median duration 47 (47-177.5)). 15 patients were resistant; 4 required third-line therapy (due to GI, neurological or cardiac involvement). 74% completely recovered.
46 patients were rechallenged. 9 developed irAEs, mostly GI (n=5). All completely responded to steroids. 3 underwent a second rechallenge (1 GI irAE reported).
17 patients died (median age 71 (62.6-79.5), median time since ICI start 222 days (173-468)). Main cause was cancer progression (n=7) and 2 died from irAE (neurologic).
Nephrotoxicity occurred in 9 cases, 4 were male, median age 61.5 (51.5-71), 78% grade 3/4 (n=7). 5 of them had other irAEs. Breast and skin cancers were the most common. 67% were under palliative treatment. Pembrolizumab was used in 6 cases. 2 didn’t respond to steroids. In 1 of them, 2^nd line treatment wasn’t pursued due to comorbidities. Rechallenge (n=5) occurred with the same ICI; 2 developed irAEs: acute kidney injury responsive to steroids, and cutaneous toxicity. 2 patients died of infections, both after approximately 1.8 years after beginning of ICI.

Conclusion

This study highlights the value of a multidisciplinary approach in managing complex irAEs, ensuring timely, evidence-based interventions and safer rechallenge strategies. Though nephrotoxicities were few, their severity and complexity underline the importance of specialized assessment in optimizing outcomes.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025r676vdte