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Clinicopathological characteristics of kidney injury in non-small cell lung cancer patients under combination therapy including pembrolizumab

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Abstract

Combination therapy, consisting of immune checkpoint inhibitors and traditional chemotherapeutic agents, has significantly improved the clinical outcomes of non-small cell lung cancer. Therefore, it will be a promising first-line therapy, whereas, there is a prospect that associated kidney injury may increase during treatment. We presented four patients, diagnosed with advanced non-small cell lung cancer, who received combination therapy, consisting of pembrolizumab, cisplatin, and pemetrexed as first-line treatment. All of them had been referred to nephrologists and had undergone renal biopsy. We observed that three of four patients presented a very rapid time course for acute kidney injury development. Notably, the three patients received only one or two cycles of the combined chemotherapy. In a renal biopsy, one patient showed severe acute tubular injury rather than interstitial nephritis. Another patient presented focal segmental glomerular sclerosis concomitant with tubulointerstitial nephritis. However, it was challenging to distinguish which agent was primarily responsible for kidney injury. Regarding the treatment, all the patients discontinued pembrolizumab and received corticosteroid treatment. We adjusted the dose and duration of corticosteroid according to the pathological results and patient conditions. The current cases provide a further understanding of clinical features and appropriate management in patients treated with combination therapy including pembrolizumab.

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Authors and Affiliations

  1. Department of Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Sae Aratani, Tetsuya Kashiwagi & Yukinao Sakai

  2. Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Address: 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Teppei Sugano, Masahiro Seike & Akihiko Gemma

  3. Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Akira Shimizu

  4. Division of Cancer Cell Biology, Institute of Medical Science, University of Tokyo, 108-8639 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Sae Aratani

Authors
  1. Sae Aratani
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  2. Teppei Sugano
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  3. Akira Shimizu
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  4. Masahiro Seike
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  5. Tetsuya Kashiwagi
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  6. Akihiko Gemma
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  7. Yukinao Sakai
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Correspondence to Sae Aratani.

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Conflict of interest

MS has received honoraria and research funding from MSD K.K, Taiho Pharmaceutical and Eli Lilly Japan K.K, outside the submitted work.

Ethical approval

This case study complied with the Helsinki Declaration standards and was approved by the Ethical Committee of Nippon Medical School Hospital. Written informed consent was obtained from all patients.

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Aratani, S., Sugano, T., Shimizu, A. et al. Clinicopathological characteristics of kidney injury in non-small cell lung cancer patients under combination therapy including pembrolizumab. CEN Case Rep 11, 97–104 (2022). https://doi.org/10.1007/s13730-021-00636-4

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  • DOI: https://doi.org/10.1007/s13730-021-00636-4

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