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Abstract: SA-PO211

Sarcoid-Like Reaction Causing Hypercalcemia and AKI in a Patient Treated with Dabrafenib and Trametinib

Session Information

Category: Onconephrology

  • 1700 Onconephrology

Authors

  • Worwa, Stefanie, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Hoteit, Mayssaa, Yale New Haven Health System, New Haven, Connecticut, United States
  • Koubar, Sahar, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Introduction

Protein kinase B-raf (BRAF) and mitogen-activated protein kinase (MEK) inhibitors are pivotal in treating melanoma. Despite efficacy, they can induce adverse events. This case presents a unique instance of hypercalcemia-induced AKI due to a sarcoid-like reaction in a melanoma patient taking dabrafenib and trametinib. Two prior cases of sarcoid-like reactions with these drugs exist, but this is the first symptomatic case.

Case Description

A 53-year-old female was diagnosed with BRAF-positive metastatic melanoma. She started therapy with immune checkpoint blockade (ipilimumab/nivolumab) and later shifted to BRAF/MEK inhibition (dabrafenib/trametinib) with nivolumab. She developed fevers, fatigue, hypercalcemia, and AKI. A lung granuloma and hilar lymph nodes were seen on chest CT. The urinalysis was bland, and the renal ultrasound was normal. Nivolumab was stopped with concern for AIN; dabrafenib and trametinib were continued. She was placed on steroids with recovery, but with any taper, her AKI and calcium would worsen (figure 1). She eventually ended therapy and tapered off steroids as her creatinine and calcium stabilized.

Discussion

AKI recurred with steroid tapers despite the absence of nivolumab. Concomitant severe hypercalcemia and a bland urinalysis suggest the AKI was hypercalcemia-induced. Other etiologies of hypercalcemia were excluded (figure 2). The hilar lymph nodes and lung granuloma likely represented a granulomatous reaction, caused by dabrafenib/trametinib, and led to hypercalcemia. Calcitriol was normal, but hypercalcemia can occur in sarcoidosis despite this. In such cases, steroids decrease levels as they slow production of 1-25 (OH)2 vitamin D. Her calcitriol level was markedly reduced with steroids.

Figure 2

Figure 1