Tumor Lysis Syndrome Following a Single Atezolizumab Infusion for Metastatic Urothelial Carcinoma Involving Both Upper and Lower Tract

Brunnhoelzl, Daniel; Weed, Michael R.; Trepet, Richard; Wang, Jue

doi:10.21767/2254-6081.1000127

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Brunnhoelzl et al published a case report of a 77-year-old female with metastatic urothelial carcinoma who presented to the hospital with anorexia, fatigue, and abdominal pain 2 weeks after her first cycle of atezolizumab [9]. Our case shares similar characteristics with this previously published case, including gender, race, type of cancer, onset of tumor lysis syndrome after single dose, and outcome.…”

Section: Discussionsupporting

confidence: 78%

“…Our case shares similar characteristics with this previously published case, including gender, race, type of cancer, onset of tumor lysis syndrome after single dose, and outcome. Also, tumor lysis syndrome was reported secondary to other forms of immunotherapy anti-PD1 and anti-CTLA4 in metastatic melanoma and renal cell carcinoma (Table 2) [9,18–21]. In our patient, in the absence of other competing etiologies for tumor lysis syndrome, patient’s high tumor burden, lack of tumor lysis syndrome prophylaxis, and the direct relationship between the onset of symptoms and treatment which make atezolizumab the more likely culprit.…”

Section: Discussionmentioning

confidence: 62%

“…Several adverse events have been associated with atezolizumab as seen in Phase 1 or Phase 2 clinical trials in urothelial cancer, but to the best of our knowledge, there is only 1 reported case of tumor lysis syndrome in a patient treated with atezolizumab for urothelial carcinoma [9]. We herein describe a case of tumor lysis syndrome following a single dose of atezolizumab for metastatic bladder cancer.…”

Section: Introductionmentioning

confidence: 95%

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A Case Report of Atezolizumab Induced Tumor Lysis Syndrome

2019

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Patient: Female, 67 Final Diagnosis: Atezolizumab induced tumor lysis syndrome Symptoms: Generalized weakness • hematuria • nausea • vomiting Medication: Atezolizumab Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: Advanced urothelial carcinoma has been associated with poor prognosis due to high resistance to chemotherapy and radiation until immunotherapeutic agents, such as atezolizumab, emerged as an option and have shown improved survival. However, atezolizumab is associated with side effects, which were mainly autoimmune. In this case study, we report on a rare case of atezolizumab-induced tumor lysis syndrome. Case Report: A 67-year-old female with a primary diagnosis of metastatic urothelial carcinoma who presented to the emergency department with generalized weakness associated with nausea and vomiting 8 days after her first cycle of atezolizumab. Laboratory values showed hyperphosphatemia, hyperuricemia, hypocalcemia, and acute kidney injury consistent with tumor lysis syndrome. Conclusions: In our report, we highlight tumor lysis syndrome as a potential reaction to atezolizumab; a condition that requires prophylaxis and close laboratory monitoring.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 95%

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A Case Report of Atezolizumab Induced Tumor Lysis Syndrome

2019

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“…The immune components necessary for clearing a dead or dying tumor were not investigated in this study but would be interesting to pursue in this particular tumor model. Antigen-specific tumor-infiltrating CD8 + T cells are needed for successful cancer immunotherapy and are considered a relevant measure of cancer vaccine efficacy [56]. As such the development of adjuvants for use in cancer therapy is an important next step for combinatorial cancer therapy platforms.…”

Section: Discussionmentioning

confidence: 99%

Simplified Admix Archaeal Glycolipid Adjuvanted Vaccine and Checkpoint Inhibitor Therapy Combination Enhances Protection from Murine Melanoma

et al. 2019

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Archaeosomes are liposomes composed of natural or synthetic archaeal lipids that when used as adjuvants induce strong long-lasting humoral and cell-mediated immune responses against entrapped antigens. However, traditional entrapped archaeosome formulations have only low entrapment efficiency, therefore we have developed a novel admixed formulation which offers many advantages, including reduced loss of antigen, consistency of batch-to-batch production as well as providing the option to formulate the vaccine immediately before use, which is beneficial for next generation cancer therapy platforms that include patient specific neo-antigens or for use with antigens that are less stable. Herein, we demonstrate that, when used in combination with anti-CTLA-4 and anti-PD-1 checkpoint therapy, this novel admixed archaeosome formulation, comprised of preformed sulfated lactosyl archaeol (SLA) archaeosomes admixed with OVA antigen (SLA–OVA (adm)), was as effective at inducing strong CD8+ T cell responses and protection from a B16-OVA melanoma tumor challenge as the traditionally formulated archaeosomes with encapsulated OVA protein. Furthermore, archaeosome vaccine formulations combined with anti-CTLA-4 and anti-PD-1 therapy, induced OVA-CD8+ T cells within the tumor and immunohistochemical analysis revealed the presence of CD8+ T cells associated with dying or dead tumor cells as well as within or around tumor blood vessels. Overall, archaeosomes constitute an attractive option for use with combinatorial checkpoint inhibitor cancer therapy platforms.

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“…Cellular death mediated by cancer therapy or spontaneous cellular lysis in rapidly dividing tumors leads to the release of intracellular contents comprised of potassium, phosphorous and uric acid. Although the vast majority of TLS cases are associated with rapidly proliferating hematologic malignancies [2], there are increasing reports of TLS in solid tumor with the availability of more effective treatment during last two decades [3][4][5][6][7][8][9][10][11][12][13]. Prior to 2017, only one case of TLS in urothelial carcinoma had been reported in literature [3,4].…”

Section: Introductionmentioning

confidence: 99%

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2019

ACCS

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Background: Tumor lysis syndrome (TLS) is an oncologic emergency with limited treatment options. Although the vast majority of TLS is associated with rapidly proliferating hematologic malignancies, it is often overlooked in solid tumor cases and has only been rarely associated with urothelial carcinomas. The objective of this review is to investigate the clinical characteristics and outcomes of TLS in patients with urothelial carcinoma.Methods: Retrospective literature and case review and pooled analysis.Results: Four cases of TLS in urothelial carcinoma were identified in over 180 published cases of TLS in solid tumors; one additional case was included from our patient database. The median age of these patients was 72 years (range: 63-77) and 60% were female. Two patients had urothelial carcinoma of the renal pelvis and three had bladder cancer with metastases. All of these cases were associated with therapy-induced TLS with a median time to event of 14 days (range: 8-22 days) after receiving chemotherapy. Laboratory parameters were consistent among all cases with elevations in uric acid and LDH, hypocalcemia, hyperphosphatemia, and hyperkalemia. Treatment for TLS included aggressive supportive measures with intravenous hydration. One patient received hemodialysis; four of the five patients received urate oxidase, while one patient received allopurinol as treatment support. The mortality in this case series was 60%. Conclusion:TLS in urothelial cancer is associated with very high mortality. TLS should be considered as a differential diagnosis when evaluating acute kidney injury and electrolyte abnormalities in patients with urothelial cancer especially in cases of high tumor volume and rapid growth.

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Tumor Lysis Syndrome Following a Single Atezolizumab Infusion for Metastatic Urothelial Carcinoma Involving Both Upper and Lower Tract

Cited by 5 publications

References 23 publications

A Case Report of Atezolizumab Induced Tumor Lysis Syndrome

A Case Report of Atezolizumab Induced Tumor Lysis Syndrome

Simplified Admix Archaeal Glycolipid Adjuvanted Vaccine and Checkpoint Inhibitor Therapy Combination Enhances Protection from Murine Melanoma

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