Tumour lysis syndrome: an unexpected adverse event associated with ipilimumab

Regnault, M. Masson; Ofaiche, J.; Boulinguez, S.; Tournier, É.; Rochaix, Philippe; Paul, C.; Lamant, Laurence; Meyer, Nicolas

doi:10.1111/jdv.13733

Cited by 15 publications

(13 citation statements)

References 8 publications

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“…23 An association between TLS with check-point inhibitors and paclitaxel has been reported previously-all cases developed within 7 days of receiving the therapy. 25,[27][28][29] In the current case, our patient was off pembrolizumab for over 4 weeks, when the development of TLS became apparent. This might suggest that paclitaxel was the triggering element, but a multifactorial etiology due to concomitant prednisone use or spontaneous lysis cannot be excluded.…”

Section: Membranoproliferative Glomerulonephritismentioning

confidence: 74%

Tubulointerstitial and intraglomerular metastasis with subsequent development of tumor lysis syndrome in a patient with advanced metastatic melanoma

Mamlouk

Lin

Zhang

et al. 2018

Journal of Onco-Nephrology

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Background: While up to 50% of patients with malignant melanoma will have micrometastases to their kidneys, clinically apparent kidney metastasis is rare. Furthermore, intraglomerular metastases have been documented in only 3% of cases of disseminated malignancies. We present an unusual case of acute kidney injury secondary to tubular injury due to tubular or vascular obstruction by melanoma and intraglomerular metastasis followed by the development of tumor lysis syndrome after treatment. Case report: A 45-year-old male with previously normal kidney function and an established diagnosis of extensive metastatic melanoma presented to the emergency department for abdominal discomfort. Despite treatment with pembrolizumab and azacitidine, he had progression of disease. Subsequently, he developed progressive, unexplainable decline in kidney function and urinalysis that was notable for white blood cells, microscopic hematuria, and microalbuminuria with hyaline casts. The kidney biopsy revealed marked infiltration of melanoma cells characterized as multifocal tubulointerstitial and intraglomerular metastases, mild tubular injury, and no evidence of nephritis. Chemotherapy with paclitaxel was initiated to reverse-presumed cancer-induced kidney injury, but within 24 h, tumor lysis syndrome developed. Despite aggressive supportive measures including hemodialysis, his clinical course was irreversible and transitioned to comfort measures. Conclusion: Acute kidney injury secondary to metastatic tubulointerstitial and intraglomerular melanoma is a rare clinical entity that should be considered as the cause of acute kidney injury in a patient with extensive disease. Patients with extensive disease should also be cautiously monitored for the development of tumor lysis syndrome during treatment.

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Section: Membranoproliferative Glomerulonephritismentioning

confidence: 74%

Tubulointerstitial and intraglomerular metastasis with subsequent development of tumor lysis syndrome in a patient with advanced metastatic melanoma

Mamlouk

Lin

Zhang

et al. 2018

Journal of Onco-Nephrology

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“…Adverse effects of these 2 drugs are most commonly immune-related reactions in the gastrointestinal, hepatic, integumentary, or neurologic systems [15,16]. According to the prescribing information, TLS is reported to be an uncommon adverse event (≥1/1,000 to <1/100) with the use of ipilimumab at the standard recommended dosing with only a handful of instances reported, while it has not been reported with the use of nivolumab [15,16,17,18,19]. Presumed TLS was documented in only 1 of 643 patients in a study of immune-related adverse events related to ipilimumab, while another study of 752 patients identified focal necrosis of an iliac lymph node metastases in 1 patient after salvage therapy with ipilimumab [18,19].…”

Section: Discussionmentioning

confidence: 99%

Acute Angle Closure Precipitated by Hemorrhage and Necrosis of a Large Uveal Melanoma in the Setting of Systemic Immunomodulatory Therapy

et al. 2017

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Management of nonmetastatic uveal melanoma has been well studied and a large body of work has been published by the Collaborative Ocular Melanoma Study (amongst many others). Management of uveal melanoma that is found to be metastatic upon initial diagnosis, however, is less well defined. We report an interesting case of acute angle closure caused by necrosis and hemorrhage into a large uveal melanoma occurring shortly after initiation of immunomodulatory therapy with ipilimumab and nivolumab for metastatic disease. The use of these immunomodulatory agents in the setting of metastatic uveal melanoma is not well studied, and our case illustrates the importance of interdisciplinary communication in order to best decide the timing of surgical and systemic medical management to optimize outcomes and minimize morbidity.

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“…Tumor lysis syndrome is one of the fatal outcomes of massive tumor cell lysis 1 . Few cases of TLS have been reported in patients with melanoma, but nearly all such cases have died 2–4 . In fact, there has only been one reported case of immune checkpoint inhibitor (Ipi)‐induced TLS among patients with melanoma 4 …”

Section: Figurementioning

confidence: 99%

Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient

Magara

Katô

Oda

et al. 2020

The Journal of Dermatology

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Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient Dear Editor, A 45-year-old man, who was referred to our clinic for an expanding melanotic macule on his abdomen, was diagnosed with malignant melanoma (T3aN0M0, stage IIA) based on a skin biopsy. Surgical removal of his tumor was performed. Five years after his first surgical procedure, inguinal and external iliac lymph node metastases were discovered and lymph node dissection was performed. Many tumor-infiltrating lymphocytes (TIL) were found in the metastatic lesions. The TIL profile consisted of cells that were positive for CD8, programmed death 1

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Tumour lysis syndrome: an unexpected adverse event associated with ipilimumab

Cited by 15 publications

References 8 publications

Tubulointerstitial and intraglomerular metastasis with subsequent development of tumor lysis syndrome in a patient with advanced metastatic melanoma

Tubulointerstitial and intraglomerular metastasis with subsequent development of tumor lysis syndrome in a patient with advanced metastatic melanoma

Acute Angle Closure Precipitated by Hemorrhage and Necrosis of a Large Uveal Melanoma in the Setting of Systemic Immunomodulatory Therapy

Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient

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