#3640 IMMUNORELATED RENAL ADVERSE EFFECTS IN PATIENTS TREATED WITH CHECKPOINT INHIBITORS

Abstract

Abstract Background and Aims Checkpoint Inhibitors (CPI) use has revolutionized cancer treatment. However, Immuno-Related Adverse Effects (IRAE) occur in more than 50% of patients. At renal level, the initial incidence of IRAE was considered low and later studies suggest between 1.4–4.9%. The aim of the study was to describe a case series with kidney dysfunction related to CPI treatment and report renal and patients’ outcomes after initiation of treatment. Methods We retrospectively studied 28 patients (72.4% male, median age 71.1 years, IR: 40.1–87.3), with metastasic neoplasms (22 advanced lung cancer, 4 melanomas, 1 renal and 1 colon) treated with CPI (Pembrolizumab 75%, 21.4% Nivolumab and 3.6% with Pembrolizumab + Ipilimumab combination) who developed AKI after CPI use, at the Complejo Hospitalario Materno Insular from January 2016 to March 2022. Demographic clinical and analytical data were collected, as well as, the evolution of kidney function. Results Immuno-related AKI occurred after a median of 3.7 months (IR: 0.23–24.0). The median plasma creatinine prior to receiving treatment with CPI was 0.9 mg/dl [IQR: 0.67-1.65]. After initiation of steroids (1mg/kg/day), 85.7% showed recovery of kidney function. Seventeen patients (60.7%) presented complete remission, 8 (28.6%) partial remission, while 3 patients (10.7%) did not recover from kidney function. In patients who did not respond initially to steroid therapy, a renal biopsy was performed (n = 7; 25.9%) showing tubulointerstitial nephritis (TIN) in 5 patients, 1 granulomatous nephritis with poor kidney function evolution, and 1 endocapillary glomerulonephritis together with TIN. More than half of the patients who developed immuno-related ARF presented toxicity in other organs (n = 13; 56.5%); being thyroiditis the most frequent (n = 3; 10.7%). At the end, two patients (7,1%) presented complete remission of neoplasms, 6 (21.4%) partial remission, stability was observed in 8 patients (28,6%), the neoplasm progress in 4 (14,3%) and 8 (28,6%) patients died during the follow-up. Finally, the patient median survival was 36,7 months ((IR 5,7- 79,6) post CPI treatment. Conclusion Immuno-related AKI after use of CPI is low; over two-thirds of patients recovered from total or partial renal function after initiation of steroids. The presence of granulomas in renal biopsy may confer poor prognosis.