60-year old female patient with nephrological irAE
Patient medical history
1
Melanoma of the skin stage IV M1c (AJCC 2017)
02/2005 superficial spreading melanoma, BRAF V600E mutated, right upper arm
03/2005 lymph node dissection, right axilla
02/2019 Distant metastases: bipulmonary, hepatic, splenic, bone and lymph node metastases
2
Medical history
10/2016 breast cancer of the left mamma (triple-negative, cT2, cN1) › surgery, radiation, adjuvant chemotherapy arterial hypertension hypothyroidism
arterial hypertension
hypothyroidism
Oncological therapy
02/2019 initiation of immunotherapy with ipilimumab and pembrolizumab
Immune related adverse event
4 weeks after the initiation of immunotherapy the patient showed an interstitial nephritis. With the creatinine levels pictured below:
Diagram 1: creatinine-level (mg/dl)
How did we proceed?
Systemic steroids were given with a rapid improvement.
Could we continue the immunotherapy?
Immunotherapy was stopped and therapy changed to BRAF/MEK-inhibitor treatment.
Our Conclusion
In general nephrological irAE after immune checkpoint blockade are rare (1%-7%) (Heinzerling et al. Dtsch Arztebl Int 2019) but mostly quickly reversible. Often immunotherapy can be reinitiated. However, in this case the therapy was changed to BRAF/MEK-inhibitors.
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