The adverse kidney effects of cancer immunotherapies

Abstract

Cancer therapies are a common cause of acute and chronic kidney disease, which are increasingly being seen by nephrologists in clinical practice. Conventional chemotherapeutic drugs and novel targeted agents are effective cancer therapies but their use is complicated by nephrotoxicity. Cancer immunotherapies exploit various properties of immune cells to enhance immune-mediated tumor killing. Interferon and high-dose interleukin-2 are older immunotherapies first employed clinically in the 1980s and 1990s to treat a number of different cancers. While effective, these two therapies have well-known systemic toxicities, which include acute kidney disease. The emergence of the new cancer immunotherapies over the past decade brings more effective treatment options. The immune checkpoint inhibitors and chimeric antigen receptor T cells are exciting additions to the cancer treatment armamentarium. These agents effectively treat a several and a growing list of cancers that have otherwise failed other therapies. However, as with the conventional and targeted cancer agents, drug-induced acute and chronic kidney disease is an untoward effect of this group of drugs. We will undertake a case-based review: the newer immunotherapies followed by the older therapies, interferon and interleukin-2.

The Nephrotoxicity of Drugs Used in Causal Oncological Therapies

“…Among irAEs nephrotoxicity is one of the rarest and reaches < 1% of patients treated with ICPs inhibitors, but, the incidence may be underestimated. Recent analysis of 48 clinical trials and 11,482 patients treated with anty- PD-1 (nivolumab and pembrolizumab) shows, that incidence rate of acute kidney injury is 2.2% [ 83 ]. In Oleas and al.…”

Onconephrology: The intersections between the kidney and cancer

“…CRS and macrophage activation can result in severe capillary leak and AKI because of hemodynamic effects or acute tubular injury. [105][106][107] A recent study in 78 patients treated with CAR-Ts for lymphoma noted CRS in 85% of patients and AKI in 19%. 108 AKI was due primarily to hemodynamic effects and ATIN.…”

“…Prevention and treatment of AKI include chemotherapy and corticosteroids before CAR-T exposure to reduce the tumor burden as well as standard supportive care in critical care units. 107 With severe CRS, an IL-6 receptor blocker may reduce adverse systemic effects. 107 Targeted cancer therapies Drugs that target mutated or overexpressed oncoproteins in cancers are also complicated by adverse renal effects (Table 1).…”

“…107 With severe CRS, an IL-6 receptor blocker may reduce adverse systemic effects. 107 Targeted cancer therapies Drugs that target mutated or overexpressed oncoproteins in cancers are also complicated by adverse renal effects (Table 1). Antiangiogenesis drugs effectively treat several cancers through inhibition of the VEGF pathway.…”

“…AKI may also occur because of TLS. Prevention and treatment of AKI include chemotherapy and corticosteroids before CAR‐T exposure to reduce the tumor burden as well as standard supportive care in critical care units 107 . With severe CRS, an IL‐6 receptor blocker may reduce adverse systemic effects 107 …”