Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors.
Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors.
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DOI：
10.1097/cmr.0000000000000646
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发表时间：
2020-04
影响因子：
2.2
通讯作者：
Izar B
中科院分区：
文献类型：
--
作者：
Thummalapalli R;Melms JC;Mier J;Izar B
免疫检查点阻断剂或RAF/MEK抑制剂的使用是转移性黑色素瘤的标准治疗选择。这些药物的每一类都有不同的反应动力学、不良反应以及独特的临床挑战。免疫检查点阻断剂和RAF/MEK抑制剂联合使用可能会产生快速且持久的疗效，然而，此类联合用药的潜在不良反应尚未得到充分研究。在此，我们描述了一名BRAF突变型黑色素瘤患者的病例，该患者在服用RAF/MEK抑制剂的同时接受了首次抗PD - 1治疗输注，并出现了严重的急性肾损伤，而这在单独使用这些药物时是一种不常见的副作用。使用糖皮质激素治疗迅速逆转了这一过程，表明存在潜在的免疫介导的并发症。在黑色素瘤和其他癌症的治疗领域，应仔细考虑对联合疗法潜在不良反应及其潜在机制的更深入理解。
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.