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Journal For Immunotherapy Of Cancer

Publication date: 2022-09-01
Volume: 10
Publisher: BMJ Publishing Group

Author:

Gupta, Shruti
Garcia-Carro, Clara ; Prosek, Jason M ; Glezerman, Ilya ; Herrmann, Sandra M ; Garcia, Pablo ; Abudayyeh, Ala ; Lumlertgul, Nuttha ; Malik, A Bilal ; Loew, Sebastian ; Beckerman, Pazit ; Renaghan, Amanda D ; Carlos, Christopher A ; Rashidi, Arash ; Mithani, Zain ; Deshpande, Priya ; Rangarajan, Sunil ; Shah, Chintan ; De Seigneux, Sophie ; Campedel, Luca ; Kitchlu, Abhijat ; Shin, Daniel Sanghoon ; Coppock, Gaia ; Ortiz-Melo, David ; Sprangers, Ben ; Aggarwal, Vikram ; Benesova, Karolina ; Wanchoo, Rimda ; Murakami, Naoka ; Cortazar, Frank B ; Reynolds, Kerry L ; Sise, Meghan E ; Soler, Maria Jose ; Leaf, David E

Keywords:

Science & Technology, Life Sciences & Biomedicine, Oncology, Immunology, ACUTE KIDNEY INJURY, Immunotherapy, Acute Kidney Injury, Adrenal Cortex Hormones, Cohort Studies, Creatinine, Humans, Immune Checkpoint Inhibitors, ICPi-AKI Consortium Investigators, 3204 Immunology, 3211 Oncology and carcinogenesis

Abstract:

BACKGROUND: Corticosteroids are the mainstay of treatment for immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI), but the optimal duration of therapy has not been established. Prolonged use of corticosteroids can cause numerous adverse effects and may decrease progression-free survival among patients treated with ICPis. We sought to determine whether a shorter duration of corticosteroids was equally efficacious and safe as compared with a longer duration. METHODS: We used data from an international multicenter cohort study of patients diagnosed with ICPi-AKI from 29 centers across nine countries. We examined whether a shorter duration of corticosteroids (28 days or less) was associated with a higher rate of recurrent ICPi-AKI or death within 30 days following completion of corticosteroid treatment as compared with a longer duration (29-84 days). RESULTS: Of 165 patients treated with corticosteroids, 56 (34%) received a shorter duration of treatment and 109 (66%) received a longer duration. Patients in the shorter versus longer duration groups were similar with respect to baseline and ICPi-AKI characteristics. Five of 56 patients (8.9%) in the shorter duration group and 12 of 109 (11%) in the longer duration group developed recurrent ICPi-AKI or died (p=0.90). Nadir serum creatinine in the first 14, 28, and 90 days following completion of corticosteroid treatment was similar between groups (p=0.40, p=0.56, and p=0.89, respectively). CONCLUSION: A shorter duration of corticosteroids (28 days or less) may be safe for patients with ICPi-AKI. However, the findings may be susceptible to unmeasured confounding and further research from randomized clinical trials is needed.