Abstract: FR-PO617
Immune Checkpoint Inhibitors as Potential Triggers for ANCA Vasculitis
Session Information
- Glomerular Diseases: Lupus and Vasculitis
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1302 Glomerular Diseases: Immunology and Inflammation
Authors
- Aqeel, Faten Faisal, Johns Hopkins University, Baltimore, Maryland, United States
- Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
- Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
Introduction
Immune checkpoint inhibitors (ICIs) have made a tremendous impact on the survival of patients with certain cancers. However, Immune-related adverse events (IrAEs) have been implicated in such therapies. Little is known about the relationship between ICIs and ANCA-associated vasculitis (AAV). We report a case of de-novo MPO ANCA positive AAV and a case of relapsing PR3 ANCA positive AAV following treatment with ICI. This observational report highlights two cases of AAV patients occurring after ICI therapy. We looked at the onset of AAV, type of ANCA, kidney biopsy results, and clinical outcomes.
Case Description
One patient developed de-novo MPO ANCA positive AAV 11 months after treatment with ICI, pembrolizumab. The second patient with relapsing PR3 ANCA positive AAV developed yet another relapse after 1 month of ICI. Both patients presented with kidney injury, proteinuria, and hematuria. Remission was achieved after rituximab and glucocorticoids treatment. (Table 1)
Discussion
ICIs, specifically PD-1 inhibitors could cause de-novo AAV or trigger a relapse of AAV. Close monitoring of disease relapse is critical in AAV patients undergoing ICI therapy.
Patient characteristics, type of cancer, ICI treatment, onset of vasculitis, ANCA type, and treatment
| ID | Age, year | Race | Sex | Type of cancer | ICI | Existing AAV before ICI | ANCA type | Timing of AAV after initiation of ICI (months) | Presenting findings | Treatment | Nadir sCr (mg/dL) | AAV status at last follow up |
| 1 | 65 | C | M | Squamous cell carcinoma of left palatine tonsil | Pembrolizumab | N | MPO | 11 | AKI (sCr 7.20) hematuria, proteinuria, foot drop | RTX + GC | 1.5 | Remission |
| 2 | 67 | C | F | Squamous cell cancer of the lung | Pembrolizumab | Y | PR3 | 1 | AKI (sCr 2.2), hematuria, proteinuria | RTX + GC | 1.8 (baseline sCr) | Remission |
AAV: ANCA associated vasculitis, ANCA: anti-neutrophil cytoplasmic antibody, ICI: Immune checkpoint inhibitor, F: female, M: male, C: Caucasian, PR3: proteinase-3, MPO: myeloperoxidase, GC: glucocorticosteroids, RTX: rituximab, AKI: acute kidney injury, sCr: serum creatinine, N: no, Y: yes