Immune-related acute kidney injury in Australian non-small cell lung cancer patients: Real-world results
- Author(s)
- Knox, A; Cloney, T; Janssen, H; Solomon, BJ; Alexander, M; Ruderman, I; John, T;
- Journal Title
- Lung Cancer
- Publication Type
- Research article
- Abstract
- BACKGROUND: The use of immune checkpoint inhibitors has altered therapeutic paradigms in NSCLC. However, they may cause immune-related toxicities, including acute kidney injury (irAKI), especially when combined with nephrotoxic agents. We investigated the incidence, management and outcomes of AKI in Australian NSCLC patients. METHODS: Medical records from a cancer centre registry were reviewed. AKI was defined and graded on absolute creatinine rise, or rise above baseline. Fishers exact test compared proportions. The Kaplan-Meier method estimated survival, and multiple logistic regression tested for risk factors. RESULTS: Of 449 patients who underwent immunotherapy from 2013 to 2021, the median age was 65 years and 61% were male. Metastatic disease was present in 68% at diagnosis, the remainder had stage Ia-III disease; 70% had adenocarcinoma; and 17% had EGFR mutations. AKI was identified in 65 patients (14.5%) of which 19 were irAKI (4.2%). Within irAKI patients, eleven (58%) had other immune-related adverse events. Median time to irAKI onset was 4 months (IQR 4-6). Seventeen (89%) patients had AKI stage 1 or 2; two had stage 3. Eleven patients developed chronic kidney disease; none required renal replacement therapy. Kidney biopsies demonstrated acute interstitial nephritis (n = 3), acute tubular necrosis (n = 1) and anti-phospholipase A2 receptor negative membranous glomerulonephritis (n = 1). Five patients were rechallenged with immunotherapy; two had recurrent irAKI. The median overall survival for those with irAKI was not reached versus 12 months with no irAKI (HR 0.35, 95 %CI 0.20-0.60, p = 0.01). Risk factors for irAKI included having an additional, non-renal irAE (OR 6.21, 95 %CI 2.35-17.26, p </= 0.01); immunotherapy combined with other cancer therapies (OR 5.62, 95 %CI 2.08-16.20, p </= 0.01); and ECOG performance status > 1 (OR 4.39 (95 %CI 1.11-14.90, p = 0.02) CONCLUSIONS: The incidence of irAKI was similar to the published literature. Renal recovery was poor, however survival was not compromised. Improved diagnostic and therapeutic strategies for irAKI would benefit this population.
- Publisher
- Elsevier
- Keywords
- Humans; Male; Aged; Female; *Carcinoma, Non-Small-Cell Lung/drug therapy; *Lung Neoplasms/drug therapy; Retrospective Studies; Australia/epidemiology; *Acute Kidney Injury/epidemiology/etiology; Acute kidney injury; Adverse event; Immune checkpoint inhibitor; Non-small cell lung cancer (NSCLC)
- Department(s)
- Medical Oncology; Pharmacy
- PubMed ID
- 37573702
- Publisher's Version
- https://doi.org/10.1016/j.lungcan.2023.107325
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-10-31 07:04:56
Last Modified: 2024-07-09 04:51:59