Hyponatraemia as a risk factor in renal cell carcinoma treatment with nivolumab.

Abstract

e14528 Background: In the general hospital population, the incidence of hyponatraemia is reported at varying levels up to 40%. In a retrospective analysis of 3,357 cancer patients (4,702 admissions) hyponatraemia was noted in 47%. A strong and independent association between hyponatraemia and longer length of stay with higher mortality was highlighted. The investigation, diagnosis and management of hyponatraemia is often inadequate in cancer patients. This poster offers recommendations for the improved diagnosis and management of hyponatraemia patients with renal cell carcinoma treated with nivolumab. Hyponatraemia occurs in 20% of patients with renal cell carcinoma and is associated with reduced survival. Patients with hyponatraemia before treatment had a median overall survival of 5.5 months compared with 18.6 months for those with normal sodium values. Methods: Key publications concerning the incidence, evaluation and management of hyponatraemia in patients with RCC as well as unpublished data from Phase III registration studies were reviewed and the data examined to consider impacts on current oncology practice Results: Hyponatraemia is a negative prognostic indicator in cancer. Data show that effective treatment of hyponatraemia in cancer patients reduces mortality. It has been shown in vitro that a hypotonic environment is pro-tumorigenic, whereas a slightly hypertonic environment may have a negative impact on clonogenicity. This may suggest a more complex impact on outcomes in cancer patients than simply the mortality associated with hyponatraemia. The presentation of hyponatraemia in cancer patients is complex and may be caused by the direct impacts of disease, iatrogenic factors or different treatment approaches Conclusions: Hyponatraemia is the most commonly occurring electrolyte disturbance in cancer patients, potentially representing a modifiable risk factor, with resultant impact on patient survival. The clinician should be aware of the potential for Immuno-oncology agents to precipitate hyponatraemia and consider that the correct diagnosis and management of hyponatraemia may further enhance efficacy and survival.