Use of the PD-1 Pathway Inhibitor Nivolumab in a Renal Transplant Patient With Malignancy

Boils, Christie L.; Aljadir, David; Cantafio, Alex W.

doi:10.1111/ajt.13786

Cited by 83 publications

(62 citation statements)

References 3 publications

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“…Although Lipson et al [51] had initially reported the successful administration of ipilimumab to 2 kidney transplantation patients with metastatic melanoma without any signs of rejection, they recently reported a case of tumor regression but allograft rejection after administration of pembrolizumab [52]. In addition, 3 cases of rejection were reported with the use of nivolumab in kidney transplant patients with melanoma [53,54,55]. Online supplementary Table 5 summarizes all 6 cases.…”

Section: Introductionmentioning

confidence: 99%

Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review

Wanchoo

Karam²,

Uppal³

et al. 2017

Am J Nephrol

11,141

256

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Background: Cancer immunotherapy, such as anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-programmed death 1 (PD-1), has revolutionized the treatment of malignancies by engaging the patient's own immune system against the tumor rather than targeting the cancer directly. These therapies have demonstrated a significant benefit in the treatment of melanomas and other cancers. Summary: In order to provide an extensive overview of the renal toxicities induced by these agents, a Medline search was conducted of published literature related to ipilimumab-, pembrolizumab-, and nivolumab-induced kidney toxicity. In addition, primary data from the initial clinical trials of these agents and the FDA adverse reporting system database were also reviewed to determine renal adverse events. Acute interstitial nephritis (AIN), podocytopathy, and hyponatremia were toxicities caused by ipilimumab. The main adverse effect associated with both the PD-1 inhibitors was AIN. The onset of kidney injury seen with PD-1 inhibitors is usually late (3-10 months) compared to CTLA-4 antagonists related renal injury, which happens earlier (2-3 months). PD-1 as opposed to CTLA-4 inhibitors has been associated with kidney rejection in transplantation. Steroids appear to be effective in treating the immune-related adverse effects noted with these agents. Key Message: Although initially thought to be rare, the incidence rates of renal toxicities might be higher (9.9-29%) as identified by recent studies. As a result, obtaining knowledge about renal toxicities of immune checkpoint inhibitors is extremely important.

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Section: Introductionmentioning

confidence: 99%

Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review

Wanchoo

Karam²,

Uppal³

et al. 2017

Am J Nephrol

11,141

256

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“…Several cases were reported of the administration of agents such as ipilimumab and nivolumab in liver or kidney transplant recipients [4–13]. No patients receiving ipilimumab developed graft rejection, whereas some of the patients receiving PD1 inhibitors presented with kidney and heart rejections and even graft loss [4, 6, 10, 14], indicating that these agents should be used with more caution in patients with vital organ transplantations (liver, heart).…”

Section: Discussionmentioning

confidence: 99%

“…However, the administration of agents that are explicitly designed to re-invigorate the T-cell response carries the clear risk of precipitating acute rejection, a lymphocytic infiltrative process, which could result in irreparable damage to the transplanted organ. Several cases have been reported of patients with kidney and liver transplants receiving checkpoint inhibitors, such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed-death 1 (PD-1) inhibitors, with increased risk of rejection appearing to be more frequent on anti-PD-1 therapy [4–13]. One patient was reported to receive anti-PD-1 therapy in the context of heart transplantation, developing an acute rejection [14].…”

Section: Introductionmentioning

confidence: 99%

Safe and effective administration of T-VEC in a patient with heart transplantation and recurrent locally advanced melanoma

Schvartsman¹,

Perez²,

Flynn³

et al. 2017

j. immunotherapy cancer

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BackgroundImmunotherapy plays a key role in the treatment of metastatic melanoma. Patients with autoimmune conditions and/or on immunosuppressive therapy due to orthotropic transplants, however, are systematically excluded from clinical trials. Talimogene laherparepvec (T-VEC) is the first oncolytic virus to be approved by the FDA for cancer therapy. To our knowledge, this is the first report of T-VEC being administered in the setting of an organ transplant recipient.Case presentationHere we present the case of a patient with recurrent locally advanced cutaneous melanoma receiving salvage T-VEC therapy in the setting of orthotropic heart transplantation. After 5 cycles of therapy, no evidence of graft rejection has been observed to date, and the patient achieved a complete remission, and is currently off therapy.ConclusionThis case advocates for further investigation on the safety and efficacy of immunotherapeutic approaches, such as T-VEC, in solid organ transplant recipients.

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“…The immune suppression regimen for both patients was reduced at least 6 weeks prior to the ipilimumab (Table 4) and the treatment was well-tolerated with partial response of the melanoma. However, more recently, two cases of acute rejection of kidney allograft after nivolumab treatment have been reported 49,50 as well as two additional cases of allograft rejections after a sequential administration of ipilimumab and nivolumab 51,52 . In all the above cases, regardless of rejection episodes, the patients’ immune suppression regimen was minimized prior to the initiation of immune checkpoint inhibitors.…”

Section: Checkpoint Inhibitors In Chronic Kidney Disease and Organ Trmentioning

confidence: 99%

Renal complications of immune checkpoint blockade

Murakami

Motwani

Riella

2017

Current Problems in Cancer

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Immune checkpoint inhibitors have been approved for a variety of cancer species. Renal complications in use of these agents are not very common compared with other immune related adverse events (irAE). However, it is crucial for physicians to recognize and manage renal manifestations of irAE. In this review, we will summarize the up-to-date knowledge of the clinical presentation, pathological features and management of renal irAE. In addition, we will discuss the safety of immune checkpoint inhibitors in patients with chronic kidney disease as well as in kidney transplant recipients.

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Use of the PD-1 Pathway Inhibitor Nivolumab in a Renal Transplant Patient With Malignancy

Cited by 83 publications

References 3 publications

Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review

Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review

Safe and effective administration of T-VEC in a patient with heart transplantation and recurrent locally advanced melanoma

Renal complications of immune checkpoint blockade

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