Abstract: FR-PO206
Rituximab in Treatment of Glomerulonephritis Induced after Immune Checkpoint Inhibitors
Session Information
- Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Alasadi, Yazen, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Arani, Naszrin, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Tchakarov, Amanda, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
- Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Introduction
Immune checkpoint inhibitors have been shown to induce and exacerbate autoimmune side effects especially in those patients with underlying autoimmune disease. Although glomerular disease is a rare entity (less than 1%), it adds further complexity to the cancer patients care. In this report we describe 4 cases of glomerulonephritis successfully treated with rituximab and resumed ICI with continued renal response.
Case Description
A 64-year-old with diagnosis of mesothelioma and treated with nivolumab, after two cycles he developed nephrotic range proteinuria with biopsy confirmation of membranous nephropathy with positive antibody to PLA2R. The patient
was initiated on rituximab 1 g IV on Day 1 and 15 and achieved complete renal response while continuing therapy on nivolumab for 3 years and PET/CT imaging ccancer remission and serum Anti-PLA2R negative.
Another patient is a 71 y.o with diagnosis of squamous cell cancer of the anal canal who did not respond to cisplatin and 5 FU and was started on nivolumab. After fourth cycle she developed 15g proteinuria. Biopsy confirmed minimal change disease and treated with a short dose of steroids and rituximab. She achieved complete remission of her proteinuria and tumor response with continued ICI treatment.
The third case is a 65 y.o male with primary membranous nephropathy 20 years ago with reactivation after Stage IV Melanoma diagnosis and exacerbated ICI treatment. Rituximab achieved excellent response and resolution of proteinuria after one cycle which was maintained on ICI for over 2 years with no exacerbation of his membranous nephropathy and complete tumor response.
Our final case is a 65 y.o. male with diagnosis of anaplastic thyroid carcinoma, treated with dabrafenib, trametinib, and pembrolizumab. 2 weeks after pembrolizumab patient developed AKI creatinine increase 3.5mg/dl, nephrotic range proteinuria. Kidney biopsy attained confirmed minimal change disease. He was treated with rituximab and proteinuria improved from 20grams to 0.5 grams. Patient was restarted on pembrolizumab and after 2 doses creatinine is less than 0.9mg/dl and proteinuria less than 1gram.
Discussion
In this report we have presented four unique cases of membranous nephropathy and minimal change disease in a cancer patient after ICI exposure successfully treated and re-challenged on ICI with continued renal and tumor response.