Rapidly progressing programmed cell death 1 inhibitor‐related pneumonitis in a hemodialytic patient with metastatic renal cell carcinoma

Abstract

Abbreviations & Acronyms AIP = acute interstitial pneumonia CT = computed tomography DAD = diffuse alveolar damage EGFR = epidermal growth factor receptor HD = hemodialysis IP = interstitial pneumonitis irAE = immune-related adverse event mTOR = mammalian target of rapamycin PD-1 = programmed cell death 1 RBC = red blood cell RCC = renal cell carcinoma VEGF = vascular endothelial growth factor WBC = white blood cell Correspondence: YoshiakiIntroduction: The efficacy and safety of nivolumab for patients receiving hemodialysis remain uncertain. Herein, we report a patient receiving a maintenance hemodialysis with life-threatening interstitial pneumonitis caused by nivolumab for metastatic renal cell carcinoma. Case presentation: A 61-year-old man with chronic kidney disease after nephrectomy for renal cell carcinoma was started on hemodialysis. Six months later, he developed multiple bone metastases and received pazopanib. Pazopanib, however, was not effective. We then switched to nivolumab as second-line treatment. Five days after the first administration of nivolumab, he complained of respiratory discomfort and malaise with oxygen desaturation. Chest computed tomography demonstrated diffuse areas of ground glass opacity in both lung fields, suggesting programmed cell death 1 inhibitorrelated pneumonitis. Prompt corticosteroid therapy led to improvement of the symptoms. Conclusion: Caution should be exercised on the administration of nivolumab to hemodialysis patients due to the risk of interstitial pneumonitis.Key words: HD patients, metastatic renal cell carcinoma, nivolumab, PD-1 inhibitorrelated pneumonitis. Keynote messageThe administration of nivolumab to HD patients with metastatic RCC may occasionally cause serious adverse effects. The present case developed life-threatening IP. The administration of nivolumab to HD patients should be conducted cautiously due to the risk of respiratory failure.