Acute renal failure in patient with renal cell carcinoma after combination immune checkpoint inhibitor therapy

Abstract

Recent advances in immunotherapy have shown great promise, especially in the setting of renal cell carcinoma with its well-known history of highly immunogenic tumor microenvironment. In particular, combination immune checkpoint inhibition with nivolumab and ipilimumab will likely soon be used as a first line regimen in the treatment of advanced renal cell carcinoma given recent trial data. However, we urge close monitoring and caution with such therapies given dual immune checkpoint blockade may potentiate the effects and lead to more severe immune-related adverse events. We present a case of a patient started on combination immune checkpoint inhibitor therapy developing acute renal failure with subsequent dialysis dependence. Our case highlights the need for a more proactive approach to preventing and monitoring for immune-related adverse events. We especially wanted to highlight the concern for nephrotoxic events in renal cell carcinoma patients given their increased vulnerability to renal insult in the setting of prior surgical interventions and underlying malignancy.

Keywords

• Immune related adverse event
• Immune checkpoint inhibitor therapy
• Acute interstitial nephritis
• Renal cell carcinoma
• Checkmate 214 trial