Nephrotoxicity of Cancer Immunotherapies: Past, Present and Future

Abstract

Nephrotoxicity from cancer therapies is common and increasingly encountered in clinical practice, such that the subfield of "onco-nephrology" has emerged. Conventional chemotherapeutic drugs and novel agents targeting specific genes/proteins are effective cancer therapies but suffer from a number of adverse kidney effects. An effective avenue of cancer treatment is immunotherapy, which uses drugs that augment immune system-mediated recognition and targeting of tumor cells. As such, leveraging the immune system to target malignant cells represents an important modality in eradicating cancer. IFN and high-dose IL-2 are older immunotherapies used in clinical practice to treat various malignancies, whereas new cancer immunotherapies have emerged over the past decade that offer even more effective treatment options. The immune checkpoint inhibitors are an exciting addition to the cancer immunotherapy armamentarium. Chimeric antigen receptor T cells are also a new immunotherapy used to treat various hematologic malignancies. However, as with the conventional and targeted cancer agents, the immunotherapies are also associated with immune-related adverse effects, which includes nephrotoxicity.

Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade

“…That this might actually be the case in SARS-CoV infection was discovered by a subsequent study that showed that an interferon-gamma-related cytokine storm was induced post-SARS-CoV, leading to severe organ damage in SARS patients [34]. This process is not new to nephrologists, as cytokine-mediated inflammatory AKI has been reported in several clinical conditions, such as treatment with immune-checkpoint inhibitors and chimaeric antigen receptor (CAR) T cells in cancer patients [35], as well as thymoglobulin treatment in renal transplanted patients [36].…”

Rapidly Progressive Acute Kidney Injury Associated with Nivolumab Treatment

“…The latter hypothesis is based on a previous report that 14 out of 19 ATIN patients, while using ICIs, combined suspected drugs such as proton pump inhibitor (PPI) and NSAIDs for drug-induced interstitial nephritis [11]. Similarly, Perazella et al [12] reviewed nephrotoxicity in cancer immunotherapies and discussed the mechanisms underlying ICI-induced kidney injury. Among them, we consider two hypotheses for the pathogenesis of AKI in the present case.…”

Nebenwirkungen neuer onkologischer Immuntherapien

“…Die Formen renaler Beteiligung durch gesteigerte Autoimmunität bei Checkpoint-Inhibition wurden in den letzten 5 Jahren zunehmend gut beschrieben [19,20]. Aktuell liegen zwei gleichermaßen rezente wie lesenswerte Studien zum Thema vor -die eine von Anker et al, erschienen in der Januarausgabe von Der Nephrologe [21,22].…”