Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy

Uppal, Nupur N.; Workeneh, Biruh; Rondon‐Berrios, Helbert; Jhaveri, Kenar D.

doi:10.2215/cjn.14671121

Cited by 22 publications

(15 citation statements)

References 97 publications

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“…Immune checkpoint inhibitors therapy can lead to hyponatremia by several mechanisms, with the syndrome of inappropriate antidiuresis being the most common. Endocrine causes of hyponatremia are rare 28 . Hypokalemia is also common and is associated with both proximal and distal renal tubular acidosis.…”

Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

“…Table 2 summarizes all novel immunotherapy-associated electrolyte disturbances recently noted in case series and case reports. 28,30 Tumor Lysis Syndrome Tumor Lysis Syndrome (TLS) is an oncological emergency. It occurs secondary to anti-cancer therapies in patients with high tumor burden or spontaneously.…”

Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

“…In addition, TLS has now been associated with novel agents such as the B-cell lymphoma 2 inhibitor venetoclax, the monoclonal antibody obinutuzumab 32,33 , and even immune checkpoint inhibitors. Although, data on such associations are related to case reports and case series 28,32,33 .…”

Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

“…Table 2 summarizes all novel immunotherapy-associated electrolyte disturbances recently noted in case series and case reports. 28,30…”

Section: Electrolyte Disorders Updatementioning

confidence: 99%

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Onconephrology 2022: An Update

et al. 2022

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Onconephrology is an upcoming and expanding subspecialty that deals with the intersections between hematology/oncology and nephrology. With the paradigm shift in the understanding of cancer immunobiology and mechanisms of onco-therapeutic drug toxicities, it is important for a nephrologist to have a sound understanding of this field. Over the last 5 years, there have been immense developments in our understanding of kidney related adverse events from various targeted, immuno and cellular-based therapies. Pathogenic mechanisms of electrolyte imbalance, hypertension (Onco-hypertension), and acute kidney injury from multiple forms of cancer therapies have been explored. Significant research has also been conducted in the field of transplant onconephrology. In this review, we have tried to assimilate the most recent updates in the last 2 years in this ever-growing and fascinating field.

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Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

Section: Immunotherapy Associated Electrolyte Disordersmentioning

confidence: 99%

“…Table 2 summarizes all novel immunotherapy-associated electrolyte disturbances recently noted in case series and case reports. 28,30…”

Section: Electrolyte Disorders Updatementioning

confidence: 99%

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Onconephrology 2022: An Update

et al. 2022

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“…As prognosis is increasingly favourable, some argue that malignancy should, at times, be considered a chronic disease [1]. However, as cancer patients generally live longer and experience a myriad of different cancer treatment options, the treatment-related toxicities are more often experienced, and this includes electrolytes’ disturbances [2,3 ▪ ]. In this article, we will review the following electrolytes abnormalities: hypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia that generally have received less emphasis in the literature compared with their counterparts’ electrolytes’ disturbances in cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Electrolytes disturbances in cancer patients

Turcotte

Achi

Mamlouk

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewHypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia are electrolytes disturbances that can arise in cancer patients in relation to unique causes that are related to the cancer itself or its treatment and can lead to delay or interruption of cancer therapy. This article summarizes these main causes, the proposed pathophysiology and the recommended management for these disturbances. Recent findingsThere have been many cancer drugs approved in the field of oncology over the past several years and a subset of these drugs have been associated with electrolytes disturbances. This includes, for example, immune checkpoint inhibitor related hyperkalemia, fibroblast growth factor 23 inhibitor associated hyperphosphatemia and epidermal growth factor receptor inhibitor associated hypomagnesemia and hypocalcaemia. SummaryThis article provides an updated review of certain electrolytes disturbance in cancer patients and allows clinicians to have a greater awareness and knowledge of these electrolyte abnormalities in efforts to early recognition and timely management.

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Hypercalcemia

Walker

Shane

2022

JAMA

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ImportanceHypercalcemia affects approximately 1% of the worldwide population. Mild hypercalcemia, defined as total calcium of less than 12 mg/dL (&lt;3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4-2 mmol/L), is usually asymptomatic but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people. Hypercalcemia that is severe, defined as total calcium of 14 mg/dL or greater (&gt;3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L) or that develops rapidly over days to weeks, can cause nausea, vomiting, dehydration, confusion, somnolence, and coma.ObservationsApproximately 90% of people with hypercalcemia have primary hyperparathyroidism (PHPT) or malignancy. Additional causes of hypercalcemia include granulomatous disease such as sarcoidosis, endocrinopathies such as thyroid disease, immobilization, genetic disorders, and medications such as thiazide diuretics and supplements such as calcium, vitamin D, or vitamin A. Hypercalcemia has been associated with sodium-glucose cotransporter 2 protein inhibitors, immune checkpoint inhibitors, denosumab discontinuation, SARS-CoV-2, ketogenic diets, and extreme exercise, but these account for less than 1% of causes. Serum intact parathyroid hormone (PTH), the most important initial test to evaluate hypercalcemia, distinguishes PTH-dependent from PTH-independent causes. In a patient with hypercalcemia, an elevated or normal PTH concentration is consistent with PHPT, while a suppressed PTH level (&lt;20 pg/mL depending on assay) indicates another cause. Mild hypercalcemia usually does not need acute intervention. If due to PHPT, parathyroidectomy may be considered depending on age, serum calcium level, and kidney or skeletal involvement. In patients older than 50 years with serum calcium levels less than 1 mg above the upper normal limit and no evidence of skeletal or kidney disease, observation may be appropriate. Initial therapy of symptomatic or severe hypercalcemia consists of hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate. In patients with kidney failure, denosumab and dialysis may be indicated. Glucocorticoids may be used as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas). Treatment reduces serum calcium and improves symptoms, at least transiently. The underlying cause of hypercalcemia should be identified and treated. The prognosis for asymptomatic PHPT is excellent with either medical or surgical management. Hypercalcemia of malignancy is associated with poor survival.Conclusions and RelevanceMild hypercalcemia is typically asymptomatic, while severe hypercalcemia is associated with nausea, vomiting, dehydration, confusion, somnolence, and coma. Asymptomatic hypercalcemia due to primary hyperparathyroidism is managed with parathyroidectomy or observation with monitoring, while severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates.

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Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy

Cited by 22 publications

References 97 publications

Onconephrology 2022: An Update

Onconephrology 2022: An Update

Electrolytes disturbances in cancer patients

Hypercalcemia

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