Checkpoint inhibitors in chronic kidney failure and an organ transplant recipient

Patient Selection for Anti-PD-1/PD-L1 Therapy in Advanced Non-Small-Cell Lung Cancer: Implications for Clinical Practice

“…However, evidence suggests that ICIs can be a well-tolerated therapeutic option in these patients [91,92]. In a study of 27 patients with advanced solid tumors and impaired cardiac, renal or hepatic function, treatment with anti-PD-1 agents was associated with tolerable irAEs and infrequent and manageable worsening of organ function [92].…”

“…In a study of 27 patients with advanced solid tumors and impaired cardiac, renal or hepatic function, treatment with anti-PD-1 agents was associated with tolerable irAEs and infrequent and manageable worsening of organ function [92]. A case series of melanoma patients with chronic kidney failure and an organ transplant recipient treated with ICIs also suggests anti-PD-1 antibodies can be used safely in patients with impaired kidney function [91]. As monoclonal antibodies are metabolized into peptides and amino acids by intracellular catabolism, and not by the liver or kidney, hepatic or renal dysfunction are likely to have little effect on the pharmacokinetics of these drugs [93].…”

Renal complications of immune checkpoint blockade

“…Limited data are available on the efficacy and toxicity of immune checkpoint inhibitors in patients with chronic kidney disease (CKD) or kidney transplant recipients, since these patient populations are generally excluded from clinical trials. Recently, Herz et al 46 reported three cases of metastatic melanoma complicated with CKD stage 3 (serum creatinine ranging from 1.48–2.10 mg/dl), who were treated with anti-PD-1 agents (nivolumab or pembrolizumab) and did not develop any significant deterioration of their kidney function.…”

Immune checkpoint inhibitors in the management of malignancies in transplant recipients

“…Based on the above case reports, pembrolizumab/nivolumab usage is associated with a higher risk of renal graft complications so that ipilimumab may be a better option as the initial therapy in these patients for melanoma 6. There is a report in which a patient was on tacrolimus and prednisone immunosuppression postrenal transplant and he was given ipilimumab followed by nivolumab with good tolerance and no graft rejection, but the clinical response to melanoma is modest 17. However, in this case, tacrolimus and prednisone were continued during immunotherapy which might have prevented graft rejection response 17…”

“…In the other case, ipilimumab was given while the patient is on tacrolimus with no evidence of tumour regression and the graft was intact 21. It should be further determined whether using immune checkpoint inhibitors while the patients are on immunosuppressive regimens decrease the clinical response rate of tumours 17. Nevertheless, in patients with melanoma, immunosuppressive regimens should be reduced to the lowest dose necessary to maintain the graft as well as get a meaningful clinical tumour response to immune checkpoint inhibitors 1…”