Immune Checkpoint Inhibitors Renal Side Effects and Management

Abstract

The choice of immunotherapy in the treatment of cancer has improved the prognosis of many patients affected by various malignancies. The high expectations foreseen with immunotherapy have led to fast approvals despite the incomplete understanding of the toxicity profiles in the different organs, including the kidneys. The high prevalence of chronic kidney disease in cancer patients complicates the issue further and requires a better knowledge of the renal safety profile to ensure an optimal safe treatment. This review summarizes the present knowledge of renal adverse events secondary to immune checkpoint inhibitors and discusses their pathophysiology, clinical presentation and adequate management. We also advocate the need for a multidisciplinary approach in patients with immune-related toxic adverse events.

Evaluation of chronic kidney disease in cancer patients: is there a preferred estimation formula?

“…As such, several equations were developed on the basis of readily available data in the clinical setting and include serum creatinine, gender, age and weight of the patient. 6 In our recent review on the onconephrology of targeted therapies and immune checkpoint inhibitors, oncologists seem to rely on the CG formula or the creatinine levels to adjust treatment dosages, a practice refuted by the conclusions of Janowitz et al [6][7][8] In this paper, we evaluate the overall agreement of the Cockcroft-Gault, MDRD and CKD-EPI equation with Janowitz's equation and search for eventual subgroups of patients where Janowitz's equation may present a diagnostic advantage. 2 Later in 1999, Levey et al elaborated the modification of diet in renal disease (MDRD) equation based on young people with CKD and lacked validation in the measurement of GFR at higher levels and in the elderly.…”

“…Recently, Janowitz et al devised a new estimation formula. 6 In our recent review on the onconephrology of targeted therapies and immune checkpoint inhibitors, oncologists seem to rely on the CG formula or the creatinine levels to adjust treatment dosages, a practice refuted by the conclusions of Janowitz et al [6][7][8] In this paper, we evaluate the overall agreement of the Cockcroft-Gault, MDRD and CKD-EPI equation with Janowitz's equation and search for eventual subgroups of patients where Janowitz's equation may present a diagnostic advantage.…”

Immune‐related Adverse Events in Cancer Patients

“…Renal insufficiency 23 and a variety of neurological syndromes 24 , including Guillain-Barré, posterior reversible encephalopathy syndrome, encephalitis, and myasthenia gravis, can result from checkpoint inhibition. [25][26][27] Eye complaints in checkpoint inhibitor patients should prompt concern for uveitis or other autoimmune ophthalmic diseases such as iridocyclitis.…”

Ipilimumab-Based Therapy: Consensus Statement From the Faculty of the Melanoma Nursing Initiative on Managing Adverse Events With Ipilimumab Monotherapy and Combination Therapy With Nivolumab

“…ADLs-activities of daily living; NSAID-nonsteroidal anti-inflammatory drug; PD-1-programmed cell death protein 1; ULN-upper limit of normal Note. Based on information from Bristol-Myers Squibb, 2017a, 2017b; Kähler et al, 2016;Kumar et al, 2017;Merck, 2017;National Cancer Institute, 2010;Rassy et al, 2016;…”