Русский
Renal injury during combination immunotherapy (ipilimumab + nivolumab) in patients with metastatic renal cell cancer who previously underwent nephrectomy
DOI: https://dx.doi.org/10.18565/urology.2025.1.68-74
Titov K.S., Epifanova M.V., Alimov A.A., Nesterova O.Yu., Shutov E.V., Lebedev S.S. Zapirov G.M.
1) S.P. Botkin’s State Clinical Hospital, Moscow, Russia; 2) Peoples' Friendship University of Russia, Moscow, Russia; 3) FGBOU DPO RMANPO, Moscow, Russia; 4) FGBOU VO Lomonosov Moscow State University, Moscow, Russia
Aim. To estimate frequency and type of renal injury in patients with metastatic renal cell carcinoma (RCC) receiving ipilimumab and nivolumab after nephrectomy.
Materials and methods. The retrospective study involved 50 patients, including 38 (76%) men and 12 (24%) women with a single kidney and progressive metastatic RCC. After nephrectomy before the start of immunotherapy for the progression of RCC, chronic kidney disease (CKD) stage 3 and higher was diagnosed in 39 (78%) cases.
Results. During immunotherapy, acute kidney injury (AKI) developed in 9 (11%) patients after 14 weeks of treatment. The maximum incidence of AKI (n=7; 25%) was documented after the 10th administration of the drugs. When assessing the dynamics of creatinine levels over 28 weeks, a significant increase was noted after the 2nd, 3rd, 4th and 10th administrations. After the 2nd administration of the drugs, the creatinine level in the total sample of patients increased on average to 159.7 μmol/l with a baseline level of 127.8 μmol/l (p<0.001), while after the 3rd, 4th and 10th administration to 160.3, 151.6 and 147.9 μmol/l, respectively (p<0.039, p=0.003 and p=0.029, respectively). Similar dynamics were also seen for urea with a significant increase after the 2nd, 3rd, 4th, 5th and 7th administrations. For example, the maximum urea level was recorded after the 3rd and 5th administrations of the drugs and was 10.2 mmol/l, while before the start of therapy it was 8.1 mmol/l (p=0.001 and p=0.003, respectively).
Conclusion. A significant renal injury was seen during 28 weeks of follow-up in patients with metastatic RCC after nephrectomy receiving ipilimumab and nivolumab.
Materials and methods. The retrospective study involved 50 patients, including 38 (76%) men and 12 (24%) women with a single kidney and progressive metastatic RCC. After nephrectomy before the start of immunotherapy for the progression of RCC, chronic kidney disease (CKD) stage 3 and higher was diagnosed in 39 (78%) cases.
Results. During immunotherapy, acute kidney injury (AKI) developed in 9 (11%) patients after 14 weeks of treatment. The maximum incidence of AKI (n=7; 25%) was documented after the 10th administration of the drugs. When assessing the dynamics of creatinine levels over 28 weeks, a significant increase was noted after the 2nd, 3rd, 4th and 10th administrations. After the 2nd administration of the drugs, the creatinine level in the total sample of patients increased on average to 159.7 μmol/l with a baseline level of 127.8 μmol/l (p<0.001), while after the 3rd, 4th and 10th administration to 160.3, 151.6 and 147.9 μmol/l, respectively (p<0.039, p=0.003 and p=0.029, respectively). Similar dynamics were also seen for urea with a significant increase after the 2nd, 3rd, 4th, 5th and 7th administrations. For example, the maximum urea level was recorded after the 3rd and 5th administrations of the drugs and was 10.2 mmol/l, while before the start of therapy it was 8.1 mmol/l (p=0.001 and p=0.003, respectively).
Conclusion. A significant renal injury was seen during 28 weeks of follow-up in patients with metastatic RCC after nephrectomy receiving ipilimumab and nivolumab.
About the Autors
Corresponding author: A.A. Alimov – Ph.D. student at the Department of the Oncology and Interventional Radiology named after V.P. Kharchenko of Peoples' Friendship University of Russia; oncologist at the Outpatient Oncology Care Center of S.P. Botkin’s State Clinical Hospital, Moscow, Russia; e-mail: alimov.oncologist@gmail.com
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