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Diagnosis, management, and outcomes of immune checkpoint inhibitor induced acute interstitial nephritis: A single-center experience.
Elghawy, Omar; Patel, Reema; Barsouk, Adam; Puthumana, Joe; Xu, Jason; Sussman, Jonathan; Horton, Bethany; Kaur, Varinder.
Afiliación
  • Elghawy O; Department of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Patel R; University of Virginia Cancer Center, Charlottesville, VA, USA.
  • Barsouk A; Department of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Puthumana J; University of Virginia Cancer Center, Charlottesville, VA, USA.
  • Xu J; Department of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Sussman J; Department of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Horton B; University of Virginia Cancer Center, Charlottesville, VA, USA.
  • Kaur V; University of Virginia Cancer Center, Charlottesville, VA, USA.
J Oncol Pharm Pract ; : 10781552241252627, 2024 May 05.
Article en En | MEDLINE | ID: mdl-38706192
ABSTRACT

BACKGROUND:

Immune checkpoint inhibitor (ICI)-associated acute interstitial nephritis (AIN) is a recognized complication of immunotherapy (IO), but literature on its management and outcomes is limited.

METHODS:

We retrospectively reviewed patients who received ICIs and developed biopsy-proven or clinically-suspected ICI-associated AIN at the University of Virginia Comprehensive Cancer Center from 2012-2023. We analyzed baseline characteristics and clinical outcomes, including treatment interruption and rechallenge rates. Acute kidney injury (AKI) was defined as a ≥ 1.5-fold increase in baseline creatinine under seven days, a two-fold increase above the upper limit of normal, or an increase by ≥0.3 mg/dL. Kidney function returning to within 0.3 mg/dL or less than twice baseline was considered complete (CRc) and partial (PRc) recovery, respectively.

RESULTS:

We identified 12 cases of ICI-AIN four by biopsy (33%) and eight (67%) by clinical suspicion. Two patients received anti-CTLA-4 and anti-PD1, six received anti-PD1 alone, and four received chemo-immunotherapy. The majority (58%) of patients developed AIN within the first 5 cycles. Eight patients developed ≥ Grade 3 AKI, and six developed multiple irAEs. ICI was permanently discontinued in seven patients (58%) and temporarily interrupted in four (30%). The CRc and PRc rates were 67% and 8%, respectively. Upon AIN onset, the best disease response was stable disease in five patients, partial response in three, and progressive disease in three. Median overall survival was 4.87 years, and progression-free survival was 1.5 years.

CONCLUSIONS:

Rechallenge with IO after kidney irAE may be possible in some patients but requires careful evaluation on an individual basis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Oncol Pharm Pract Asunto de la revista: FARMACIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Oncol Pharm Pract Asunto de la revista: FARMACIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido