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Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors.

Abstract

The use of either immune checkpoint blockade or RAF/MEK inhibitors represents standard of care treatment options for metastatic melanoma. Each class of these drugs has distinct response kinetics, adverse effects, and unique clinical challenges. Combination of immune checkpoint blockade and RAF/MEK inhibitors may result in rapid and durable responses, however, the potential adverse effects of such combinations are poorly characterized. Here, we describe the case of a patient with BRAF-mutant melanoma who received an initial infusion of anti-PD-1 therapy while taking RAF/MEK inhibitors and experienced severe acute kidney injury, an otherwise infrequent side effect of any of these drugs alone. Treatment with corticosteroids rapidly reversed this process, indicating an underlying immune-mediated complication. A deeper understanding of potential adverse effects of combination therapies and their potential mechanisms should be carefully considered in the treatment landscape for melanoma and other cancers.

Authors+Show Affiliations

Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. Department of Medical Oncology, Dana-Farber Cancer Institute.Department of Medical Oncology, Dana-Farber Cancer Institute.Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston.Department of Medical Oncology, Dana-Farber Cancer Institute. Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634214

Citation

Thummalapalli, Rohit, et al. "Rapid Evolution of Acute Kidney Injury After Initial Infusion of Pembrolizumab in a Melanoma Patient Concurrently Treated With RAF/MEK Inhibitors." Melanoma Research, 2019.
Thummalapalli R, Melms JC, Mier J, et al. Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors. Melanoma Res. 2019.
Thummalapalli, R., Melms, J. C., Mier, J., & Izar, B. (2019). Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors. Melanoma Research, doi:10.1097/CMR.0000000000000646.
Thummalapalli R, et al. Rapid Evolution of Acute Kidney Injury After Initial Infusion of Pembrolizumab in a Melanoma Patient Concurrently Treated With RAF/MEK Inhibitors. Melanoma Res. 2019 Oct 17; PubMed PMID: 31634214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors. AU - Thummalapalli,Rohit, AU - Melms,Johannes C, AU - Mier,James, AU - Izar,Benjamin, Y1 - 2019/10/17/ PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2019/10/22/medline JF - Melanoma research JO - Melanoma Res. N2 - The use of either immune checkpoint blockade or RAF/MEK inhibitors represents standard of care treatment options for metastatic melanoma. Each class of these drugs has distinct response kinetics, adverse effects, and unique clinical challenges. Combination of immune checkpoint blockade and RAF/MEK inhibitors may result in rapid and durable responses, however, the potential adverse effects of such combinations are poorly characterized. Here, we describe the case of a patient with BRAF-mutant melanoma who received an initial infusion of anti-PD-1 therapy while taking RAF/MEK inhibitors and experienced severe acute kidney injury, an otherwise infrequent side effect of any of these drugs alone. Treatment with corticosteroids rapidly reversed this process, indicating an underlying immune-mediated complication. A deeper understanding of potential adverse effects of combination therapies and their potential mechanisms should be carefully considered in the treatment landscape for melanoma and other cancers. SN - 1473-5636 UR - https://www.unboundmedicine.com/medline/citation/31634214/Rapid_evolution_of_acute_kidney_injury_after_initial_infusion_of_pembrolizumab_in_a_melanoma_patient_concurrently_treated_with_RAF/MEK_inhibitors L2 - http://dx.doi.org/10.1097/CMR.0000000000000646 DB - PRIME DP - Unbound Medicine ER -