Renal Effects after Pembrolizumab Treatment for Non-small Cell Lung Carcinoma

Oki, Rikako; Hirakawa, Yosuke; Kimura, Hiroyuki; Honda, Kenjiro; Hinata, Munetoshi; Abé, Hiroyuki; Domoto, Yukako; Tanaka, Goh; Nagase, Takahide; Nangaku, Masaomi

doi:10.2169/internalmedicine.3928-19

Cited by 20 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Renal complications occurred in 7 patients (1.7%), including 6 patients (1.5%) with grade >3 [ 43 ]. The case of tubulointerstitial nephritis with IgA nephropathy following the use of pembrolizumab was also reported [ 44 ].…”

Section: Nephrotoxicity In the Immunological Treatment Of Neoplasmsmentioning

confidence: 99%

Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer

Jagieła

Bartnicki

Rysz

2021

IJMS

View full text Add to dashboard Cite

Acute kidney injury is a common complication of many medical procedures, including those used in cancer treatment. Both chemotherapy and immunotherapy may result in deterioration of kidney function, which may lead to an increase in mortality among patients with cancer. Antineoplastic agents can affect any element of the nephron, leading to the appearance of clinical symptoms such as proteinuria, hypertension, electrolyte disorders, glomerulonephritis, acute and chronic interstitial nephritis and acute kidney injury. The medical literature describing renal complications occurring during chemotherapeutic and immunotherapeutic treatment in neoplasms, such as colorectal cancer, non-small cell lung cancer and melanoma, was analysed. The immune system plays an important role in controlling the development of neoplasms and fighting them. Oncological treatment algorithms include immunotherapy as monotherapy, combined with chemotherapy or chemotherapy as monotherapy. In the treatment of the above-mentioned neoplasms immunotherapeutics are used, such as checkpoint inhibitors (CPI) (i.e., ipilimumab, pembrolizumab, nivolumab, atezolizumab), vascular endothelial growth factor (VEGF) inhibitors (i.e., bevacizumab, ramucirumab) and a variety of chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, gefitinib, erlotinib, gemcitabine, cisplatin, paclitaxel, carboplatin, doclitaxel, vinorelbine, topotecan, etoposide). In our article, we focused on the number and type of renal complications as well as on the time of their manifestation when using specific treatment regimens. Our analysis also includes case reports. We discussed treatment of immunological complications and adjustments of the dose of chemotherapeutic agents depending on the creatinine clearance. Analysing the data from the literature, when two immunotherapeutic agents are used together, the number of recorded renal complications increases. Bevacizumab and ramucirumab are the cause of the largest number of renal complications among the immunotherapeutic agents described above. Cisplatin is the best-described substance with the greatest nephrotoxic potential among the chemotherapeutic agents. Crucial for renal complications are also cancer stage, previous chemotherapy and other risk factors of AKI such as age, comorbidities and medications used. Due to the described complications during oncological treatment, including kidney damage, it seems necessary to elaborate standards of cooperation between oncologists and nephrologists both during and after treatment of a patient with cancer. Therefore, it is necessary to conduct further research and develop algorithms for management of a cancer patient, especially during such an intensive progress in oncology.

show abstract

Section: Nephrotoxicity In the Immunological Treatment Of Neoplasmsmentioning

confidence: 99%

Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer

Jagieła

Bartnicki

Rysz

2021

IJMS

View full text Add to dashboard Cite

show abstract

“…9 It is known that tubulointerstitial injuries can occur secondary to various conditions, other than induced by pembrolizumab, including IgA nephropathy and arteriolosclerosis. 10 Nephrologists identified both conditions and ruled them out in this patient, however the proteinogram and urine sediment were normal. The patient was not biopsied, but he was diagnosed with interstitial nephritis as the most likely event.…”

Section: Discussionmentioning

confidence: 83%

“…8 On the one hand, there is no clear consensus on the effectiveness of steroid therapy for ATIN, due to the fact that there have been no randomized, controlled studies. 10 On the other hand, according to the pharmaceutical reference of pembrolizumab (KEYTRUDA), only if creatinine levels are elevated to grade III (serum creatinine >3.0Âbaseline), treatment with systemic steroids, such as prednisolone (1-2 mg/kg), will be recommended. 1 In our case, creatinine levels elevated >3.0 Âbaseline.…”

Section: Discussionmentioning

confidence: 99%

Interstitial nephritis with pembrolizumab: A case report and review

Bejarano

Pérez

Rueda

et al. 2020

J Oncol Pharm Pract

View full text Add to dashboard Cite

Introduction Pembrolizumab is a monoclonal antibody approved for adult patients with advanced non–small-cell lung cancer (NSCLC). Although immune related adverse events are considered to be well tolerated, complications may occur and discontinuation of the treatment could be required. Case report A 62-year old patient diagnosed with advanced non-small cell lung cancer experienced a decline in the renal function after seven cycles with pembrolizumab. Management & outcome: After ruling out other common causes of interstitial nephritis, pembrolizumab was attributed as a cause of interstitial nephritis. At first, toxicity was managed with corticosteroids and closely monitoring the patient, but finally pembrolizumab had to be discontinued due to the kidney function did not recover. Discussion Renal and urinary disorders were reported in <3% of patients treated with pembrolizumab, being interstitial nephritis the most reported toxicity. The kidney damage can be a complication to consider in patients receiving pembrolizumab. Early identification of an increase in serum creatinine levels may help with prevention by establishing an effective treatment, although it may not mean a total recovery of kidney function.

show abstract

“…Since the Food and Drug Administration (FDA) approved it in 2011, there were only four cases of biopsyproven CPI-associated IgA nephropathy and all were described with programmed death-1 (PD-1) inhibitors use. [5][6][7][8] In comparison, there were more reported cases of MCD and they were in association with both cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and PD-1 antibodies. 9 The degree of proliferative changes on biopsy, proteinuria, treatment, and the outcome of these cases were variable.…”

Section: Discussionmentioning

confidence: 99%

A case of relapsing immunoglobulin A nephropathy secondary to immunotherapy

Mamlouk

Workeneh

2020

Journal of Onco-Nephrology

View full text Add to dashboard Cite

An estimated 3% of patients treated with immune checkpoint inhibitors develop acute kidney injury during the treatment course. The majority of biopsy-proven checkpoint inhibitor–associated nephropathy is related to acute interstitial nephritis, but various glomerulonephritides have been reported, including immunoglobulin A nephropathy and minimal change disease. Secondary immunoglobulin A nephropathy can be associated with autoimmune and infectious disease, but, unlike minimal change disease, rarely as a result of medications. To date, there are no clear evidences that treating secondary immunoglobulin A nephropathy or minimal change disease with immunosuppression therapy provides resolution for glomerulonephritis. We report the first case of remission of checkpoint inhibitor–induced overlap immunoglobulin A/minimal change disease nephropathy treated with repository corticotrophin therapy.

show abstract

Renal Effects after Pembrolizumab Treatment for Non-small Cell Lung Carcinoma

Cited by 20 publications

References 11 publications

Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer

Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer

Interstitial nephritis with pembrolizumab: A case report and review

A case of relapsing immunoglobulin A nephropathy secondary to immunotherapy

Contact Info

Product

Resources

About