Thursday, June 20, 2019

Topic Discussion: Tumor Lysis Syndrome with immunotherapy


At this point the nephrology and oncology community is very aware of the AIN, glomerular diseases including vasculitis and ATN seen with check point inhibitors… but we might not be aware of tumor lysis syndrome that this drug can entice in certain patients. 

In the last 2 years, I found several published reports of TLS with check point inhibitors.
Here is a table I created to help with the theme on this one

Immunotherapy
Age
Gender
Cancer type
Time to TLS
Dialysis needed?
Outcome
Reference
Nivolumab
76
Male
Melanoma
5
Yes but declined
Disease progression-death

Atezolizumab
77
Female
GU cancer
14
Yes
Disease progression-death

Atezolizumab
-
-
Solid tumor
-
-
-

Atezolizumab
-
-
Solid tumor
-
-
-

Ipilumumab
73
Male
Melanoma
6
No
Death

Nivolumab
74
Male
RCC
2
No
Death



Based on this, it is seen with PD-1, PDL1 and CTLA4 inhibitors and melanoma and urological cancers. A recent review in JON showed a case of a patient getting TLS with melanoma.  So it’s hard to tell if these agents are causing it or is it the burden of tumor- usually solid tumors in these cases.

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