Renal Allograft Failure After Ipilimumab Therapy for Metastatic Melanoma: A Case Report and Review of the Literature

José, A. De la Fuente Hernández; Yiannoullou, Petros; Bhutani, Shiv; Denley, Helen; Morton, Michael; Picton, Michael; Summers, Angela; Dellen, David van; Augustine, Titus

doi:10.1016/j.transproceed.2016.07.019

Cited by 50 publications

(22 citation statements)

References 19 publications

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“…Immunosuppression may predispose to cancer by inhibiting immune surveillance, suppressing DNA repair, and predisposing to oncogenic viral infections (48)(49)(50). Although transplant recipients have been excluded from all clinical trials of ICPIs to date, based on the concern of triggering rejection upon blockade of immune inhibitory signals, case reports and small case series of transplanted recipients receiving ICPIs have begun to emerge with conflicting results (51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62). We reviewed all published case reports and case series and found that the rejection rate with ipilimumab monotherapy was 33% compared to 52% in patients receiving anti-PD-1 monotherapy (Figure 3) (63).…”

Section: What Are Special Considerations In Transplant Patients?mentioning

confidence: 99%

Immune Checkpoint Inhibitor Nephrotoxicity: Update 2020

et al. 2020

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Immune checkpoint inhibitors (ICPIs) have transformed the landscape of oncology, but are associated with a variety of autoimmune adverse events, including AKI. ICPI-associated AKI (ICPI-AKI) is emerging as an increasingly frequent cause of AKI in patients with cancer, and poses unique diagnostic and management challenges to clinicians who care for these patients. In this review, we describe the incidence and risk factors for ICPI-AKI, including proton pump inhibitor use, CKD, and combination immunotherapy. We discuss the limitations of the various definitions used for ICPI-AKI in prior studies, and propose a novel classification system (definite, probable, and possible ICPI-AKI) that recognizes the diagnostic uncertainty inherent in many cases. We discuss the key clinicopathologic features and treatment strategies for ICPI-AKI, including the role of kidney biopsy versus empirical treatment with steroids. We also explore the under-studied area of ICPI use in the setting of solid organ transplantation, where nephrologists and oncologists must balance the risk of rejection versus treating the underlying malignancy. Finally, we summarize existing data on the role of ICPI rechallenge after an episode of ICPI-AKI.

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Section: What Are Special Considerations In Transplant Patients?mentioning

confidence: 99%

Immune Checkpoint Inhibitor Nephrotoxicity: Update 2020

et al. 2020

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“…At these doses, ipilimumab induced dose‐limiting GVHD in 14% of the patients and irAEs in 21% (including 1 death), but it also induced several durable disease responses . Several other case reports of advanced melanoma treated with ipilimumab after solid organ or stem cell transplantation have suggested reasonable tolerance with only a single episode of rejection in a renal transplant patient …”

Section: Transplantmentioning

confidence: 96%

“…15 Several other case reports of advanced melanoma treated with ipilimumab after solid organ or stem cell transplantation have suggested reasonable tolerance with only a single episode of rejection in a renal transplant patient. [16][17][18][19][20][21] Anti-PD1/PD-L1 has also been used safely in several patients after hematopoietic stem cell transplantation. 16,[22][23][24][25][26] However, several cases of renal and cardiac allograft rejection and serious GVHD have also been reported soon after the initiation of anti-PD1 in patients with various advanced malignancies.…”

Section: Transplantmentioning

confidence: 99%

Immune checkpoint inhibitors in challenging populations

Johnson

Sullivan

Menzies

2017

Cancer

292

200

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Immune checkpoint inhibitors, including those targeting the PD-1/PD-L1 and CTLA-4 pathways, are revolutionizing cancer therapeutics. Both activity and toxicities largely stem from unleashing tumor- or host-specific cytotoxic T cells. Many patients seen in routine clinical practice did not qualify for, or were seriously underrepresented in immune checkpoint inhibitor clinical trials. Thus, a major gap in knowledge regarding the safety and efficacy of these agents persists in many populations, even following regulatory approval. To address this challenge, we aggregated and synthesized the available pre-clinical and clinical data surrounding immune checkpoint inhibitor therapy in challenging clinical populations to assist treatment decision making for both academic and community oncologists. Specifically, we focus on the safety and activity of immune checkpoint inhibitors in patients with autoimmune disorders, post-organ transplant, chronic viral infections, ongoing immunosuppressant use, organ dysfunction, pregnancy, brain metastases, extremes of age, and impaired functional status.

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“…A total of 26 patients have previously been described in the literature (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), with the majority of them from two centers,(2,3) and mostly receiving HD (92%). A variety of malignancies were treated (melanoma 35%, and renal cell carcinoma 54%, with the remainder composed of squamous cell skin cancer, urothelial cancer, and non-small cell lung cancer).…”

Section: Review Of the Literaturementioning

confidence: 99%