Adverse Renal Effects of Anticancer Immunotherapy: A Review

Abstract

Modern oncological therapy utilizes various types of immunotherapy. Immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cells (CAR-T) therapy, cancer vaccines, tumor-targeting monoclonal antibodies (TT-mAbs), bispecific antibodies and cytokine therapy improve patients’ outcomes. However, stimulation of the immune system, beneficial in terms of fighting against cancer, generates the risk of harm to other cells in a patient’s body. Kidney damage belongs to the relatively rare adverse events (AEs). Best described, but still, superficially, are renal AEs in patients treated with ICIs. International guidelines issued by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) cover the management of immune-related adverse events (irAEs) during ICI therapy. There are fewer data concerning real occurrence and possible presentations of renal adverse drug reactions of other immunotherapeutic methods. This implies the need for the collection of safety data during ongoing clinical trials and in the real-life world to characterize the hazard related to the use of new immunotherapies and management of irAEs.

Onconephrology: mitigation of renal injury in chemotherapy administration

“…There are various newer agents that are developed in each of these classes (see ]. Some electrolyte disturbances like hyponatremia [6] can be attributed to endocrine and renal injury from ICI's, and TLS maybe caused by them as well [50,53]. For the spectrum of parenchymal renal injury, ICIs typically cause interstitial nephritis that has been shown various times clinically and on renal biopsy.…”

“…As ever more advanced signaling systems became involved in cancer treatments, toxicities emerged which only the oncologists understood at first [1 A common organ system involved in complications of chemotherapy is the renal system. From the changes in serum electrolytes due to dying cancer cells, to interference in cellular repair in the glomerulus and to direct toxicity of renal endothelial and podocyte cells caused by anticancer treatments, every new therapy has surfaced potential toxicity beyond what was known from the basic antidividing cell side effects of antimetabolite chemotherapy [6,7 This was seen at first with intravenous vascular endothelial growth factor inhibitor agents, implicated in vascular events, glomerular disease, and thrombotic microangiopathy. Then down the line, immune checkpoint inhibitors, helped define the field of onconephrology as nephrologists became accustomed to balancing its wonderous potential for cancer remission, with the occurrence of severe endocrine glandular disorders and renal interstitial nephritis [9 && ].…”

“…A common organ system involved in complications of chemotherapy is the renal system. From the changes in serum electrolytes due to dying cancer cells, to interference in cellular repair in the glomerulus and to direct toxicity of renal endothelial and podocyte cells caused by anticancer treatments, every new therapy has surfaced potential toxicity beyond what was known from the basic antidividing cell side effects of antimetabolite chemotherapy [6,7 ▪▪ ,8 ▪ ].…”

“…The workings of the immune system, once thought to be immutable, have become controllable by physicians. It is the onconephrologists who stand guard on the kidneys helping to balance the risks of side effects against the wonderous healing potential of the next generation of chemotherapeutic agents [6,10,11 ▪ ,12,13,14 ▪▪ ].…”

“…In this review, we will discuss various categories of chemotherapeutic agents, discuss the known literature regarding their renal toxicities, with a focus on mitigation strategies and ability to predict which patients are at risk for renal injury [1 ▪▪ ,6,10,11 ▪ ,12,13,14 ▪▪ ,15 ▪ ,16 ▪ ]. Onconephrology field, is ever expanding, functioning as a sub-subspecialty knowledge base that is treasured and not easily available everywhere [1 ▪▪ ].…”