Abstract: FR-PO1245
Unusual Presentation of AKI in Patients with Non-Small Cell Lung Cancer Treated with Amivantamab: A Case Series
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Cancarevic, Ivan, Mass General Brigham Inc, Boston, Massachusetts, United States
- Shah, Sujal I., Mass General Brigham Inc, Boston, Massachusetts, United States
- Gupta, Shruti, Mass General Brigham Inc, Boston, Massachusetts, United States
Introduction
Amivantamab, an antibody targeting the epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition factor (MET), is increasingly used for non-small cell lung cancer (NSCLC). Nephrotoxicity of it is unknown, with data limited to clinical trials reporting a rise in serum creatinine (SCr). Here we describe 3 cases of biopsy-proven acute interstitial nephritis (AIN), with all 3 showing wedge-shaped, hypodense lesions on imaging.
Case Description
Case 1 is a 55 y/o M with metastatic NSCLC who had a rise in SCr from a baseline of 1 to 2.1 mg/dL 6 months after starting amivantamab. CT abdomen/pelvis (CTAP) revealed bilateral wedge-shaped hypodensities of unclear etiology. MRA was unrevealing. Serologies were notable for an elevated IL-10 and C-reactive protein. Kidney biopsy showed moderate AIN, similar to immune check point inhibitor (ICI)-associated AIN, along with tubular injury (Figure 1). Despite treatment with steroids and infliximab, he had minimal renal recovery and was transitioned to osimertinib. Case 2 is a 79 y/o F with metastatic NSCLC who had a rise in SCr from 0.7 to 1.5 mg/dL 5 months after starting amivantamab. A kidney biopsy showed mild AIN and tubular injury without necrosis. CTAP showed a hypodense lesion in the right kidney. With a course of steroids, her SCr stabilized at 1.3 mg/dL. Case 3 is a 65 y/o F with NSCLC, initially controlled with osimertinib, then with cancer progression. She was switched to amivantamab, but had a rise in SCr from 0.9 to 1.5 mg/dL 5 months later. CTAP showed bilateral wedge-shaped hypoenhancements. Kidney biopsy showed mainly tubular injury and mild AIN. Treatment with steroids did not lead to improvement in SCr. Both cases 2 and 3 had an elevated soluble IL-2 receptor.
Discussion
Although all three patients were also treated with carboplatin and pemetrexed, the pathology, biochemistry and imaging suggest a more complex pathology, likely related to amivantamab. Response to steroids was poor compared with other anti-cancer agents that cause AIN, like ICIs.