Case reportSuccessful treatment by pembrolizumab in a patient with end-stage renal disease with advanced non-small cell lung cancer and high PD-L1 expression
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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Cited by (16)
Insuffisance d'organe (cŒur, rein, foie) et traitements du cancer pulmonaire
2023, Revue des Maladies Respiratoires ActualitesReal-world outcomes of chemotherapy for lung cancer patients undergoing hemodialysis: A multicenter retrospective cohort study (NEJ-042)
2022, Lung CancerCitation Excerpt :However, there were none of the three patients on this study who received nivolumab exhibited significant response or severe adverse events. anti-PD-1 antibodies have been used successfully in cancer patients receiving HD [13–18]. Renal function has no effect on the pharmacokinetics of monoclonal antibodies such as nivolumab and pembrolizumab [19–21], because no significant effect on the clearance of the drugs because monoclonal antibodies are metabolized to peptides and amino acids just as endogenous immunoglobulin G. Thus, anti-PD1 or PD-L1 monoclonal antibodies do not require dose adjustment for patients with renal dysfunction.
Pembrolizumab in hemodialysis patients. Is it safe?
2020, NefrologiaImmunotherapy in Dialysis-Dependent Cancer Patients: Our Experience in Patients With Metastatic Renal Cell Carcinoma and a Review of the Literature
2019, Clinical Genitourinary CancerCitation Excerpt :Dialysis treatment seems to have no effect on the pharmacokinetics of nivolumab, mainly because it is primarily metabolized and excreted by the endothelial reticulum system and not by the kidneys. There are currently few published data available on the use of nivolumab and other checkpoint inhibitors in dialysis-dependent patients (Table 4).14-28 In the literature, 21 patients with different types of cancer treated with ICB during dialysis are described (Table 4) and only 7 with mRCC.14-28
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Shiho Ishizuka and Shinya Sakata contributed equally to this work.