Nivolumab‐induced severe acute kidney injury with a long latent phase in a patient with non‐small‐cell lung cancer: A case report

Uchida, Naohiro; Tsuji, Seijiro; Fujita, Kohei; Koizumi, Mitsuteru; Moriyoshi, Koki; Mio, Tadashi

doi:10.1002/ccr3.1848

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…A randomized, multicenter phase III study (CheckMate-459) of nivolumab vs sorafenib in patients with advanced HCC is currently ongoing to examine the use of nivolumab as a first-line treatment[ 288 ]. The renal toxicity profile of nivolumab is similar to that of pembrolizumab, including AKI, acute tubular injury, and immune complex-mediated glomerulonephritis[ 284 , 289 , 290 ]. The FDA label contains special warnings, prescribes precaution for immune-mediated nephritis and renal dysfunction during use, and advises that patients should be monitored for changes in renal function.…”

Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

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The population of patients with hepatocellular carcinoma (HCC) overlaps to a high degree with those for chronic kidney disease (CKD) and end-stage renal disease (ESRD). The degrees of renal dysfunction vary, from the various stages of CKD to dialysis-dependent ESRD, which often affects the prognosis and treatment choice of patients with HCC. In addition, renal dysfunction makes treatment more difficult and may negatively affect treatment outcomes. This study summarized the possible causes of the high comorbidity of HCC and renal dysfunction. The possible mechanisms of CKD causing HCC involve uremia itself, long-term dialysis status, immunosuppressive agents for postrenal transplant status, and miscellaneous factors such as hormone alterations and dysbiosis. The possible mechanisms of HCC affecting renal function include direct tumor invasion and hepatorenal syndrome. Finally, we categorized the risk factors that could lead to both HCC and CKD into four categories: Environmental toxins, viral hepatitis, metabolic syndrome, and vasoactive factors. Both CKD and ESRD have been reported to negatively affect HCC prognosis, but more research is warranted to confirm this. Furthermore, ESRD status itself ought not to prevent patients receiving aggressive treatments. This study then adopted the well-known Barcelona Clinic Liver Cancer guidelines as a framework to discuss the indicators for each stage of HCC treatment, treatment-related adverse renal effects, and concerns that are specific to patients with pre-existing renal dysfunction when undergoing aggressive treatments against CKD and ESRD. Such aggressive treatments include liver resection, simultaneous liver kidney transplantation, radiofrequency ablation, and transarterial chemoembolization. Finally, focusing on patients unable to receive active treatment, this study compiled information on the latest systemic pharmacological therapies, including targeted and immunotherapeutic drugs. Based on available clinical studies and Food and Drug Administration labels, this study details the drug indications, side effects, and dose adjustments for patients with renal dysfunction. It also provides a comprehensive review of information on HCC patients with renal dysfunction from disease onset to treatment.

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Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

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“…We report a case of a patient who developed a grade 3 AKI and further a grade 3 autoimmune hepatitis under dual checkpoint inhibitor therapy despite receiving oral steroids according to current guidelines. Several reports of acute interstitial nephritis (AIN) under nivolumab therapy have been published [ 3 , 5 , 6 , 7 ]. However, to our knowledge, this is the first report of AIN developing despite ongoing steroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Development of Nivolumab/Ipilimumab-Associated Autoimmune Nephritis during Steroid Therapy

Gebauer

Bechtel-Walz

Schell

et al. 2021

Case Rep Nephrol Dial

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Immunotherapy using immune checkpoint inhibitors revolutionized therapies for a variety of malignancies. Nivolumab, an antibody blocking programmed cell death 1 protein, and ipilimumab that blocks cytotoxic T-lymphocyte-associated protein 4 effectively target tumor cells by disinhibiting the endogenous immune response. At the same time, unrestrained T-cell activation may trigger a range of immune-mediated side effects including kidney injury. Steroid therapy constitutes the mainstay of treatment of these adverse events, but dosage, route of administration, and approach to nivolumab re-exposure remain unclear. Here, we report the case of a 72-year-old male patient who developed severe nivolumab/ipilimumab-associated acute kidney injury while on oral steroid therapy for immune-mediated colitis. Acute interstitial nephritis was confirmed by renal biopsy. Administration of high-dose intravenous steroid doses was required to revert declining renal function.

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“…It is worth remembering the fact that ICI-induced AKI was described not only after the treatment with ipilimumab but after other ICIs as well. There were also reported cases of nephrotoxicities associated with pembrolizumab [ 52 , 75 , 76 ] and nivolumab [ 77 , 78 , 79 ].…”

Section: Immune Checkpoint Inhibitors (Icis)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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Nivolumab‐induced severe acute kidney injury with a long latent phase in a patient with non‐small‐cell lung cancer: A case report

Cited by 11 publications

References 6 publications

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Development of Nivolumab/Ipilimumab-Associated Autoimmune Nephritis during Steroid Therapy

Adverse Renal Effects of Anticancer Immunotherapy: A Review

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