Thrombotic microangiopathy associated with cetuximab, an epidermal growth factor receptor inhibitor

Koizumi, Mitsuteru; Takahashi, Masahiro; Murata, Maki; Kikuchi, Yūko; Seta, Koichi; Yahata, Kensei

doi:10.5414/cn108901

Cited by 8 publications

(5 citation statements)

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“…In the literature, only 5 cases of NS due to cetuximab and panitumumab have been reported. [5][6][7][8][9] Nephrotic syndrome developed with cetuximab in 4 cases and panitumumab in 1 case. The characteristics of these patients were summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

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Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer

Korkmaz

Hendem

Eryılmaz

et al. 2022

J Oncol Pharm Pract

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Introduction Cetuximab, an anti-EGFR monoclonal antibody, often cause skin toxicity, most commonly acneiform rash. We present a rare case of glomerulonephritis associated with cetuximab therapy. Case Report A 58-year-old male patient recently completed cetuximab-based chemotherapy for metastatic colorectal adenocarcinoma. He presented with acute renal failure, anasarca edema and nephrotic proteinuria. The amount of protein in the 24-h urine test was over 15.6 grams. Management & Outcome The patient showed a dramatic improvement in renal function shortly after terminated of cetuximab therapy without immunosuppressive therapy. Discussion Therefore, drugs targeting epidermal growth factor receptor (EGFR) monoclonal antibody were thought to trigger nephrotic syndrome by causing glomerular damage. As a result, physicians using EGFR monoclonal inhibitors should be very careful about renal functions and proteinuria in patients.

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Section: Discussionmentioning

confidence: 99%

“…Clinicopathological features of glomerular diseases associated with anti-EGFR monoclonal antibody in cancer patients [5][6][7][8][9]. …”

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confidence: 99%

Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer

Korkmaz

Hendem

Eryılmaz

et al. 2022

J Oncol Pharm Pract

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“…Unlike this case, our patient's renal function did not improve after 4 weeks of immunosuppressive therapy. Koizumi et al [ 9 ] reported a kidney biopsy with glomerular features of TMA due to cetuximab administration. Administration of cetuximab was discontinued and, nine weeks after the discontinuation of cetuximab, the proteinuria decreased.…”

Section: Discussionmentioning

confidence: 99%

Cetuximab-Associated Crescentic Diffuse Proliferative Glomerulonephritis

Manthri

Bandaru

Chang

et al. 2017

Case Reports in Nephrology

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Cetuximab-induced nephrotoxicity is very rare, occurring in less than 1% of colorectal cancer patients and not defined in other populations. We report a rare case of crescentic diffuse proliferative glomerulonephritis (GN) that developed in close temporal association with cetuximab treatment. A 65-year-old female recently completed chemotherapy with cetuximab treatment for moderately differentiated oral squamous cell carcinoma. She was admitted with acute renal failure and nephrotic-range proteinuria. Laboratory data showed serum creatinine of 6.6 mg/dl and urinalysis showed proteinuria, moderate hemoglobinuria, hyaline casts (41/LPF), WBC (28/HPF), and RBC (81/HPF). Serologic studies were negative for ANA, anti-GBM, ANCA, hepatitis B, and hepatitis C. Serum C3 and C4 level were normal. Renal biopsy showed crescentic diffuse proliferative GN with focal features of thrombotic microangiopathy. Patient was started on cyclophosphamide and steroids. Her renal function did not improve on day 8 and she was started on hemodialysis. Previous reports suggest that EGFR-targeting medications can possibly trigger or exacerbate an IgA-mediated glomerular process leading to renal failure. This case suggests that cetuximab therapy may have triggered or exacerbated a severe glomerular injury with an unfavorable outcome. Treating physicians should maintain a high degree of caution and monitor renal function in patients on EGFR inhibitors.

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“…Furthermore, there were reported cases of AKIs and nephrotic syndromes in patients treated with cetuximab. Histopathological findings in these cases included crescentic diffuse proliferative glomerulonephritis [ 121 ], diffuse proliferative glomerulonephritis [ 122 ] and TMA [ 123 ].…”

Section: Tumor-targeting Monoclonal Antibodies (Tt-mabs)mentioning

confidence: 99%

Adverse Renal Effects of Anticancer Immunotherapy: A Review

Borówka

Łącki-Zynzeling

Nicze

et al. 2022

Cancers

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Modern oncological therapy utilizes various types of immunotherapy. Immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cells (CAR-T) therapy, cancer vaccines, tumor-targeting monoclonal antibodies (TT-mAbs), bispecific antibodies and cytokine therapy improve patients’ outcomes. However, stimulation of the immune system, beneficial in terms of fighting against cancer, generates the risk of harm to other cells in a patient’s body. Kidney damage belongs to the relatively rare adverse events (AEs). Best described, but still, superficially, are renal AEs in patients treated with ICIs. International guidelines issued by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) cover the management of immune-related adverse events (irAEs) during ICI therapy. There are fewer data concerning real occurrence and possible presentations of renal adverse drug reactions of other immunotherapeutic methods. This implies the need for the collection of safety data during ongoing clinical trials and in the real-life world to characterize the hazard related to the use of new immunotherapies and management of irAEs.

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Thrombotic microangiopathy associated with cetuximab, an epidermal growth factor receptor inhibitor

Cited by 8 publications

References 0 publications

Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer

Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer

Cetuximab-Associated Crescentic Diffuse Proliferative Glomerulonephritis

Adverse Renal Effects of Anticancer Immunotherapy: A Review

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