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Nephrotoxicity of immune checkpoint inhibitor combination therapy in patients with advanced renal cell carcinoma: a meta-analysis

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A Letter to the Editor to this article was published on 07 June 2023

Abstract

Purpose

Few data are available regarding the nephrotoxicity of immune checkpoint inhibitor (ICI) combination therapy in advanced renal cell carcinoma (RCC). This study aimed to investigate the nephrotoxicity of ICI-based combination therapy versus standard of care sunitinib in patients with advanced RCC.

Methods

We searched Embase/PubMed/Cochrane Library for relevant randomized controlled trials (RCTs). Treatment-related nephrotoxicities including increase of creatinine and proteinuria were analyzed by Review Manager 5.4 software.

Results

Seven RCTs involving 5239 patients were included. The analysis showed that ICI combination therapy had similar risks of any grade (RR = 1.03, 95% CI: 0.77–1.37, P = 0.87) and grade 3–5 (RR = 1.48, 95% CI: 0.19–11.66, P = 0.71) increased creatinine compared with sunitinib monotherapy. However, ICI combination therapy was associated with significantly higher risks of any grade (RR = 2.33, 95% CI: 1.54–3.51, P < 0.0001) and grade 3–5 proteinuria (RR = 2.25, 95% CI: 1.21–4.17, P = 0.01).

Conclusions

This meta-analysis suggests that ICI combination therapy shows more nephrotoxicity of proteinuria than sunitinib in advanced RCC, which deserves a high attention in the clinic.

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Data availability

Date related to this article can be obtained from the corresponding author on request.

Abbreviations

PD-1:

Programmed cell death protein-1

PD-L1:

Programmed cell death 1 ligand 1

ICI:

Immune checkpoint inhibitor

CTLA-4:

Cytotoxic T lymphocyte antigen 4

RR:

Relative risk

RCT:

Randomized controlled trial

AKI:

Acute kidney injury

RCC:

Renal cell carcinoma

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Acknowledgements

The authors would like to thank The Third Affiliated Hospital of Guangxi Medical University.

Funding

There is no funding for this study.

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Authors and Affiliations

  1. Department of pharmacy, The Third Affiliated Hospital of Guangxi Medical University, Dan-Cun Road No.13, Nanning, Guangxi, China

    An-ju Tan, Ka Wu, Hong-mei Pan, Dong-mei Wang, Xing-xin Xu, Min-hong Chen, Shu-ying Pan, Rou Li, Wen-jiao lian & Meng-han Wei

  2. Radiotherapy Department, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China

    Dun-chang Mo

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Contributions

All the authors contributed to the study conception and design. Study design, data collection and analysis were performed by A-jT, D-cM, KW and X-xX. The first draft of the manuscript was written by A-jT and D-cM, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to An-ju Tan.

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Tan, Aj., Mo, Dc., Wu, K. et al. Nephrotoxicity of immune checkpoint inhibitor combination therapy in patients with advanced renal cell carcinoma: a meta-analysis. World J Urol 41, 1563–1571 (2023). https://doi.org/10.1007/s00345-023-04407-x

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