Immune checkpoint inhibitor associated reactivation of primary membranous nephropathy responsive to rituximab

被引:25
作者
Lin, Jamie S. [1 ]
Wang, Daniel Y. [2 ]
Mamlouk, Omar [1 ]
Glass, William F. [3 ]
Abdelrahim, Maen [4 ,5 ]
Yee, Cassian [6 ,7 ]
Abudayyeh, Ala [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Div Internal Med, Sect Nephrol, Houston, TX 77030 USA
[2] Baylor Coll Med, Dept Internal Med, Sect Hematol Oncol, Houston, TX 77030 USA
[3] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Dept Pathol & Lab Med, Houston, TX 77030 USA
[4] Houston Methodist Canc Ctr, Inst Acad Med, Dept Med Oncol, Houston, TX USA
[5] Houston Methodist Canc Ctr, Weill Cornell Med Coll, Houston, TX USA
[6] Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Melanoma Med Oncol, Houston, TX 77030 USA
[7] Univ Texas MD Anderson Canc Ctr, Dept Immunol, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
case reports; immunotherapy; autoimmunity; MALIGNANT PLEURAL MESOTHELIOMA; A(2) RECEPTOR ANTIBODIES; CANCER; CORRELATE; THERAPY; CELLS; RISK;
D O I
10.1136/jitc-2020-001287
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The same mechanisms that mediate antitumor immunity from checkpoint inhibitors (CPIs) can also lead to unintended targeting of normal tissues, characterized as immune-related adverse events (irAEs). Those with pre-existing autoimmune disease are believed to be particularly vulnerable for exacerbating underlying autoimmunity or inducing severe irAEs. We report the first case of CPI-associated reactivation of primary membranous nephropathy (MN) in a patient with pleural mesothelioma responding to immunotherapy. Due to its specificity in targeting B-lymphocytes, rituximab was used to treat primary MN with the expectation that this would not interfere with the benefits gained from T cell-mediated antitumor immunity. Rituximab was effective in treating CPI-associated reactivation of MN, and the patient was successfully rechallenged with nivolumab and maintained stable kidney function and sustained clinical antitumor effect. While exacerbation of pre-existing autoimmune diseases from CPIs is common, therapy for autoimmune reactivation can be rationally directed by an understanding of the immunosuppressive mechanism with goals of cancer treatment.
引用
收藏
页数:5
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