Autori: Alessandra Molteni, Giulia Bedino
Affiliazioni: Nefrologia ospedale Regionale Civico Lugano
Background. The development of renal toxic effects from novel anticancer drug represent a serious problem for oncologist, nephrologist and patients, because often lead to discontinuation of treatment or dose reduction with loss of efficacy of potentially life-prolonging treatments.
We report a case of a patient with disseminated melanoma treated with pembrolizumab that induced acute interstitial nephritis successfully treated with steroids without pembrolizumab discontinuation. Pembrolizumab is anti-PD-1 receptor antibodies, a new treatment of metastatic melanoma. This class of drugs presents an high risk the development of pathologic autoimmunity organ injury and it is possible that they can induce an immuno-related form of kidney injury and acute or delayed interstitial nephritis.
Case report. A 69-year-old woman with recurrence of cutaneos melanoma with mediastinic adenopathy and pulmonary lesions was treated with Pembrolizumab from August 2017. After 21 days of treatment the eGFR decreased from 60 ml/min/1.73m2 to 40 ml/min/1.73m2. After 2 months of therapy the eGFR drops to 15 ml/min/1.73m2 and a renal biospy was performed. The biopsy showed a severe tubulinterstitial nephritis. After multidisciplinary discussion between oncologists and nephrologists the patient was treated with corticosteroids but Pembrolizumab was not stopped, because of the severity of the oncological disease. After 2 weeks of steroids the renal function improved considerably (eGFR from 15 ml/min/1.73m2 to 38 ml/min/1.73m2) and then substancially remained stable after 2 months.
Conclusion. This case highlights that anti-PD-1 immunotherapy can be continued in case of acute interstitial nephritis with adequate treatment and this requires close interaction between oncologists and nephrologists. This knowledge could prevent unnecessary discontinuation of oncological treatments that prolong life in many cases.
Figura 1 (anatomia patologica)Figura 2 (andamento creatininemia)