Is Rechallenge Appropriate in Patients that Develop Immune Checkpoint Inhibitor-Associated AKI?: PRO

Herrmann, Sandra M.

doi:10.34067/kid.0003962021

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…When necessary, it is suggested to switch to H2RAs. This is particularly important when PPI or another AIN-associated drug is used in the setting of rechallenge with ICI therapy [ 95 ].…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitors and their interaction with proton pump inhibitors–related interstitial nephritis

Miao

Herrmann

2023

Clinical Kidney Journal

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Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy and outcomes, leading to an expanding use in millions of patients worldwide. However, they can cause a spectrum of immune-related adverse events (irAEs). Essentially, any organs can be affected by irAEs, which has emerged as therapy-limiting side effects. In the kidneys, ICI-associated acute interstitial nephritis (ICI-AIN) leads to acute kidney injury (AKI) in 2–5% of patients on ICI therapy. AKI associated with ICI therapy pathologically presents with AIN in nearly 90% of the cases, but the pathophysiology of ICI-AIN remains to be defined. The generation of autoreactive T cells in patients receiving AIN-inducible drugs, such as proton pump inhibitors (PPIs), is one of the leading theories, supported by a higher incidence of ICI-AIN in patients on these AIN-inducible drugs. In this review, we will discuss our understanding of the incidence, potential pathophysiological mechanisms, clinical presentations, risk factors, diagnosis, and management of PPI-related AIN and its interaction with ICI therapy.

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“…When necessary, it is suggested to switch to H2RAs. This is particularly important when PPI or another AIN-associated drug is used in the setting of rechallenge with ICI therapy [ 95 ].…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitors and their interaction with proton pump inhibitors–related interstitial nephritis

Miao

Herrmann

2023

Clinical Kidney Journal

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“…However, several retrospective studies including a multicenter study found a relatively low risk of AKI recurring after ICI rechallenge. 5 , 17 , 18 Treatment of ICI-induced sarcoid-like reaction is controversial. Little published scientific information exists regarding rechallenging ICI after immune-related adverse effects, especially after sarcoid-like reactions develop.…”

Section: Discussionmentioning

confidence: 99%

“…In our patient’s case, rechallenging with ICI instead of combination ICI therapy might have been an option, as shown in some cases of ICI-induced AIN. 18 Reinitiating ICI therapy with concurrent low-dose corticosteroid treatment may also be an option for patients with ICI-related sarcoid-like reactions.…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor–Associated Sarcoidosis Reaction in the Kidney: Case Report

Charkviani¹,

Herrmann²

2023

Kidney Medicine

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“…However, these studies included only a few patients treated with ICIs. A recent study including 37 patients with ICI-related AKI and 13 with non-ICIrelated AKI found that at the time of AKI diagnosis, the ratio of URBP relative to urine creatinine was significantly higher (median [IQR] 1927[IQR] [1174 vs. 233 [127,989]) in patients with ICIrelated AKI compared to those with the non-ICI-related AKI (22).…”

Section: Urinary Markersmentioning

confidence: 99%

Immune checkpoint inhibitor related nephrotoxicity: Advances in clinicopathologic features, noninvasive approaches, and therapeutic strategy and rechallenge

Miao

Sise²,

Herrmann³

2022

Front. Nephrol.

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Immune checkpoint inhibitors (ICIs) are used increasingly to treat more than 17 cancers and have shown promising therapeutic results. However, ICI use can result in a variety of immune-related adverse events (IRAEs) which can occur in any organ, including the kidneys. Acute kidney injury (AKI) is the most common nephrotoxicity, classically related to acute interstitial nephritis. Much more diverse patterns and presentations of ICI-related kidney injury can occur, and have implications for diagnostic and therapeutic management approaches. In this review, we summarize the recently approved ICIs for cancer, the incidence and risk factors for nephrotoxicity, our current understanding of the pathophysiological mechanisms and the key clinicopathological features of ICI-related AKI, and therapeutic strategies. We also explore important knowledge that require further investigation, such as the risks/benefits of ICI rechallenge in patients who recover from an episode of ICI-related AKI, and the application of liquid biopsy and microbiome to identify noninvasive biomarkers to diagnose and predict kidney injury and guide ICI therapy.

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Is Rechallenge Appropriate in Patients that Develop Immune Checkpoint Inhibitor-Associated AKI?: PRO

Abstract: This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the CON: 10.34067/KID.0003902021 and the COMMENTARY 10.34067/KID.0005592021

Cited by 10 publications

References 13 publications

Immune checkpoint inhibitors and their interaction with proton pump inhibitors–related interstitial nephritis

Immune checkpoint inhibitors and their interaction with proton pump inhibitors–related interstitial nephritis

Immune Checkpoint Inhibitor–Associated Sarcoidosis Reaction in the Kidney: Case Report

Immune checkpoint inhibitor related nephrotoxicity: Advances in clinicopathologic features, noninvasive approaches, and therapeutic strategy and rechallenge

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