Case report
Successful treatment by pembrolizumab in a patient with end-stage renal disease with advanced non-small cell lung cancer and high PD-L1 expression

https://doi.org/10.1016/j.resinv.2018.03.005Get rights and content

Abstract

We report a 66-year-old Japanese male with end-stage renal disease (ESRD) and advanced non-small cell lung cancer (NSCLC) who was on hemodialysis. The patient harbored high programmed death ligand 1 (PD-L1) expression and was successfully treated with pembrolizumab. Laboratory examination upon diagnosis showed elevated serum creatinine (6.58 mg/dL). We administered pembrolizumab (200 mg/body) and repeated every 3 weeks. His renal dysfunction gradually progressed, hemodialysis was initiated after eight courses of pembrolizumab, and the antitumor effect was maintained at five months after hemodialysis initiation. Therefore, pembrolizumab can be administered for patients with ESRD and advanced NSCLC, who harbor high PD-L1 expression, during preparation for hemodialysis.

Introduction

Patients with metastatic non-small cell lung cancer (NSCLC) with chronic kidney disease (CKD) or end-stage renal disease (ESRD) who are also on hemodialysis have poor prognoses and limited therapeutic options. An anti-programmed death-1 (PD-1) antibody was recently approved in Japan for the treatment of metastatic NSCLC. Pembrolizumab, an anti-PD-1 antibody, has shown favorable antitumor efficacy in metastatic melanoma and NSCLC [1], [2]. Patients with untreated metastatic NSCLC with high levels of programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥50%) who were treated with pembrolizumab showed a significant survival benefit [3]. However, there have been no reports describing the safety and efficacy of pembrolizumab in patients with advanced NSCLC and CKD or ESRD who are also on hemodialysis. To our knowledge, this is the first report of successful pembrolizumab treatment in a patient with advanced NSCLC and ESRD who was on hemodialysis.

Section snippets

Case report

A 66-year-old Japanese male with a 4-year history of CKD, due to diabetes mellitus, was admitted to our hospital because of an abnormal chest shadow. He had a 40 pack/year smoking history, and his Eastern Cooperative Oncology Group performance status was 0. The results of laboratory examinations showed elevated serum creatinine (6.58 mg/dL; normal range <1.04 mg/dL) and blood urea nitrogen (53.6 mg/dL; normal range <22.0 mg/dL), and a reduced estimated glomerular filtration rate (e-GFR)

Discussion

Although the overall survival of patients with NSCLC has been markedly improved by new molecular targeted agents (such as tyrosine kinase inhibitors of the epidermal growth factor receptor, anaplastic lymphoma kinase, and c-ros oncogene 1) and new immune checkpoint inhibitor immunotherapies have been introduced, there are few evidence-based chemotherapy regimens for patients with metastatic NSCLC with CKD or ESRD, in part because it is difficult to conduct clinical trials for these patients.

In

Conflict of interest

All authors declare no conflicts of interest.

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Shiho Ishizuka and Shinya Sakata contributed equally to this work.

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