Case of the Month

60-year old female patient with nephrological irAE

Patient medical history
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
Medical history
10/2016 breast cancer of the left mamma (triple-negative, cT2, cN1) › surgery, radiation, adjuvant chemotherapy arterial hypertension hypothyroidism
arterial hypertension
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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