A network meta-analysis of the risk of immune-related renal toxicity in cancer patients treated with immune checkpoint inhibitors
Abstract
Background: We performed a network meta-analysis of the risk of immune-related renal toxicity associated with immune checkpoint inhibitors. Methods: Eligible studies included randomized trials of patients with immune checkpoint inhibitors; describing events of immune-related renal toxicity. Results: Compared with chemotherapy control, immune checkpoint inhibitors carry a higher risk of all-grade (but not high-grade) immune-related renal toxicity. The risk with both nivolumab/ipilimumab combination was higher than the risk with either ipilimumab or nivolumab alone (odds ratio: 0.47 [95% credible interval: 0.21–0.99] and 0.11 [95% credible interval: 0.03–0.29]); for nivolumab/ipilimumab combination versus ipilimumab or nivolumab monotherapy). Conclusion: Our meta-analysis demonstrated that the use of immune checkpoint inhibitors is associated with an increased risk of all-grade immune-related renal toxicity compared with chemotherapy control.
Papers of special note have been highlighted as: • of interest
References
- 1 . Cancer immunotherapy: moving beyond current vaccines. Nat. Med. 10(9), 909–915 (2004).
- 2 . Immunologic checkpoints in cancer therapy: focus on the programmed death-1 (PD-1) receptor pathway. Pharmgenomics Pers. Med. 7, 357 (2014).
- 3 Improved survival with ipilimumab in patients with metastatic melanoma. N. Engl. J. Med. 363(8), 711–723 (2010).
- 4 Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N. Engl. J. Med. 364(26), 2517–2526 (2011).
- 5 Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N. Engl. J. Med. 369(2), 134–144 (2013).
- 6 Pembrolizumab versus ipilimumab in advanced melanoma. N. Engl. J. Med. 372(26), 2521–2532 (2015).
- 7 Pembrolizumab for the treatment of non–small-cell lung cancer. N. Engl. J. Med. 372(21), 2018–2028 (2015).
- 8 Phase I safety and pharmacokinetic study of ct-011, a humanized antibody interacting with PD-1, in patients with advanced hematologic malignancies. Clin. Cancer Res. 14(10), 3044–3051 (2008).
- 9 Disabling immune tolerance by programmed death-1 blockade with pidilizumab after autologous hematopoietic stem-cell transplantation for diffuse large B-cell lymphoma: results of an international Phase II trial. J. Clin. Oncol. 31(33), 4199–4206 (2013).
- 10 . Efficacy, safety and predictive biomarker results from a randomized phase II study comparing atezolizumab (MPDL3280A) vs docetaxel in 2L/3L NSCLC (POPLAR). J. Clin. Oncol. 33 (2015).
- 11 Safety and activity of anti-PD-l1 antibody in patients with advanced cancer. N. Engl. J. Med. 366(26), 2455–2465 (2012).
- 12 . Risk of cutaneous toxicities in patients with solid tumors treated with immune checkpoint inhibitors: a meta-analysis. Future Oncol. 11(17), 2471–2484 (2015).
- 13 . Risk of elevated transaminases in cancer patients treated with immune checkpoint inhibitors: a meta-analysis. Expert Opin. Drug Saf. 14(10), 1507–1518 (2015).
- 14 . Risk of endocrine complications in cancer patients treated with immune check point inhibitors; a meta-analysis. Future Oncol. (2015).
- 15 . Risk of gastrointestinal complications in cancer patients treated with immune checkpoint inhibitors; a meta-analysis. Immunotherapy 7(11), 1213–1227 (2015).
- 16 Safety and activity of PD1 blockade by pidilizumab in combination with rituximab in patients with relapsed follicular lymphoma: a single group, open-label, Phase 2 trial. Lancet Oncol. 15(1), 69–77 (2014).
- 17 . Endocrine side effects induced by immune checkpoint inhibitors. J. Clin. Endocrinol. Metab. 98(4), 1361–1375 (2013).
- 18 . Endocrine side-effects of anti-cancer drugs: mAbs and pituitary dysfunction: clinical evidence and pathogenic hypotheses. Eur. J. Endocrinol. 169(6), R153–R164 (2013).
- 19 . Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. Ann. Intern. Med. 151(4), 264–269 (2009).
- 20 Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control. Clin. Trials 17(1), 1–12 (1996).
- 21 . Simultaneous comparison of multiple treatments: combining direct and indirect evidence. Br. Med. J. 331(7521), 897 (2005).
- 22 . Combination of direct and indirect evidence in mixed treatment comparisons. Stat. Med. 23(20), 3105–3124 (2004).
- 23 Nivolumab versus docetaxel in advanced squamous cell non-small-cell lung cancer. N. Engl. J. Med. (2015).
- 24 Nivolumab in previously untreated melanoma without braf mutation. N. Engl. J. Med. 372(4), 320–330 (2015).
- 25 Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (checkmate 037): a randomised, controlled, open-label, Phase 3 trial. Lancet Oncol. 16(4), 375–384 (2015). • In this study, all grade renal toxicities happen in two patients (0.7%) in the nivolumab arm versus no patients in the chemotherapy arm.
- 26 Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N. Engl. J. Med. 373(17), 1627–1639 (2015).
- 27 Pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory melanoma (keynote-002): a randomised, controlled, Phase 2 trial. Lancet Oncol. 16(8), 908–918 (2015).
- 28 Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. N. Engl. J. Med. 372(21), 2006–2017 (2015).
- 29 Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N. Engl. J. Med. 373(1), 23–34 (2015).
- 30 . Immune checkpoints aberrations and gastric cancer; assessment of prognostic value and evaluation of therapeutic potentials. Crit. Rev. Oncol. Hematol. (2015).
- 31 . At the bench: preclinical rationale for CTLA-4 and PD-1 blockade as cancer immunotherapy. J. Leukoc. Biol. 94(1), 25–39 (2013).
- 32 Regulation of surface and intracellular expression of CTLA4 on mouse T cells. J. Immunol. 157(11), 4762–4770 (1996).
- 33 Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N. Engl. J. Med. 366(26), 2443–2454 (2012).
- 34 Kidney injuries related to ipilimumab. Invest. New Drugs 32(4), 769–773 (2014).
- 35 . Anti-ctla4 antibody-induced lupus nephritis. N. Engl. J. Med. 361(2), 211–212 (2009).
- 36 . Proteinuria in patients with solid tumors treated with ramucirumab: a systematic review and meta-analysis. Chemotherapy 60(5–6), 325–333 (2014).
- 37 . Management of immune-related adverse events and kinetics of response with ipilimumab. J. Clin. Oncol. 30(21), 2691–2697 (2012).
- 38 . Ipilimumab granulomatous interstitial nephritis. Am. J. Ther. 22(3), e84–e87 (2015).
- 39 Nivolumab versus everolimus in advanced renal-cell carcinoma. N. Engl. J. Med. 373(19), 1803–1813 (2015).
- 40 . Radiologic manifestations of immune-related adverse events in patients with metastatic melanoma undergoing anti–CTLA-4 antibody therapy. AJR Am. J. Roentgenol. 197(6), W992–W1000 (2011).