Akdeniz Üniversitesi Tıp Fakültesi Hastanesi’nde Nivolumab Tedavisi Uygulanmış Olan Hastalarda Akut Böbrek Hasarının Retrospektif Olarak Değerlendirilmesi

Öz

Amaç: İmmünoterapi, kanser tedavisinde kullanım alanı gittikçe genişleyen ve daha sık tercih edilen bir tedavi seçeneği olarak ön plana çıkmaktadır. Bu yeni tedavi yöntemi, immün sistemin aktivasyonunu artırarak malignitelere karşı savunmayı güçlendirmektedir. Ancak, immün sistemin bu şekilde aktive edilmesi bazı immün yan etkilerin ve toksisitelerin görülmesine de yol açabilmektedir. Bu çalışmada, bir tür immün kontrol noktası inhibitörü (ICPI) olan nivolumab ile tedavi gören kanser hastalarında tedavi sürecinde gelişen akut böbrek hasarının insidansını, klinik özelliklerini ve olası risk faktörlerini retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntemler: Bu çalışmada, nivolumab ile tedavi gören kanser hastalarında akut böbrek hasarının (ABH) görülme sıklığını, risk faktörlerini ve klinik sonuçlarını değerlendirdik. Bu amaçla, retrospektif olarak nivolumab ile tedavi edilen kanser hastalarının tıbbi kayıtları incelendi. ABH gelişen hastalarda; tedavi süreleri, kullanılan ilaç türleri, böbrek fonksiyonlarındaki değişiklikler, ekstrarenal yan etki gelişimi değerlendirildi. Bulgular: Çalışmaya 143 hasta alındı. Bu hastaların 116’sı erkek, 27’si kadındı. Yirmi üç hastada ABH gelişti. Hiçbir hastaya böbrek biyopsisi yapılarak immün kontrol noktası inhibitörü ilişkili (ICPI) nefrotoksisite kanıtlanmamıştır. ABH gelişen hastaların %30,4’ünde kronik böbrek hastalığı (KBH), %30,4’ünde exitus gelişmiş, %39,2’si iyileşmiştir. Başlangıç nötrofil/lenfosit oranı ve trombosit/lenfosit oranı yüksek olması ve eozinofil düşük olması ile nivolumab sonrası ABH gelişimi arasında anlamlı ilişki saptanmıştır. Nivolumab tedavisi sırasında nonsteroidal antiinflamatuar ilaç (NSAİD), proton pompa inhibitörü (PPİ) veya antibiyotik kullanımının ABH gelişimi ile ilişkisi saptanmamıştır. Ekstrarenal yan etkiler, komorbid hastalıklar ve kanser türü ile ABH gelişimi arasında ilişki saptanmamıştır. Sonuç: ICPI'ler, kanser tedavisinde önemli bir yer tutmakla birlikte, nefrotoksisite gibi ciddi yan etkilere de yol açabilmektedir. Bu nedenle, nivolumab ile tedavi gören hastaların böbrek fonksiyonlarının yakından izlenmesi büyük önem taşımaktadır. Bu çalışma, nivolumab tedavisi alan kanser hastalarında tedavi sürecinde gelişen akut böbrek hasarının insidansı, klinik özellikleri ve risk faktörlerine ilişkin bulgularıyla mevcut literatüre katkı sağlamayı amaçlamaktadır.

Anahtar Kelimeler

• İmmünoterapi
• Nivolumab
• Nefrotoksisite

Retrospective Evaluation of Acute Kidney Injury In Patients Treated with Nivolumab at Akdeniz University Faculty of Medicine Hospital

Öz

Objective: Immunotherapy is a treatment option that is being used more and more frequently in cancer treatment. This new treatment method strengthens the defense against malignancies by increasing immune system activation. However, this activation of the immune system may also lead to some immune side effects and toxicities. In this study, we aimed to retrospectively investigate the incidence, clinical characteristics, and potential risk factors of acute kidney injury (AKI) occurring during treatment in cancer patients treated with nivolumab, a type of immune checkpoint inhibitor (ICPI). Material and Methods: In this study, we evaluated the incidence, risk factors and clinical outcomes of acute kidney injury (AKI) in cancer patients treated with nivolumab. For this purpose, medical records of cancer patients treated with nivolumab were retrospectively reviewed. Duration of treatment, types of drugs used, changes in renal function, and development of extrarenal side effects were evaluated in patients with AKI. Results: The study included 143 patients. Of these patients, 116 were male and 27 were female. Twenty-three patients developed AKI. ICPI-related nephrotoxicity was not proven by performing a renal biopsy in any patient. Of the patients who developed AKI, 30,4% developed chronic kidney disease (CKD), 30,4% developed exitus, and 39,2% recovered. High baseline neutrophil/lymphocyte ratio and platelet/lymphocyte ratio and low baseline eosinophils were significantly associated with the development of AKI after nivolumab. The use of non-steroidal anti-inflammatory drugs (NSAID), proton pump inhibitors (PPI) or antibiotics during nivolumab treatment was not associated with the development of AKI. Extrarenal side effects, comorbid diseases and cancer type were not associated with the development of AKI. Conclusion: Although ICPIs play an important role in cancer treatment, they can also cause serious side effects such as nephrotoxicity. Therefore, close monitoring of renal function in patients treated with nivolumab is of great importance. This study aims to contribute to the existing literature by presenting findings on the incidence, clinical characteristics, and potential risk factors of AKI occurring during treatment in cancer patients treated with nivolumab.

Anahtar Kelimeler

• Immunotherapy
• Nivolumab
• Nephrotoxicity

Kaynakça

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