Acute kidney injury following crizotinib administration for non-small-cell lung carcinoma

Area of Science:

• Oncology
• Nephrology
• Pharmacology

Background:

• Locally advanced non-small-cell lung carcinoma (NSCLC) requires effective treatment strategies.
• Chemotherapy regimens like cisplatin, bevacizumab, and pemetrexed may not always achieve adequate disease control.
• Targeted therapies, such as crizotinib for EML4-ALK positive NSCLC, offer alternative treatment options.

Observation:

• A patient with NSCLC initially treated with standard chemotherapy experienced inadequate disease control.
• Following genetic identification of an echinoderm microtubule-associated protein like 4-anaplastic lymphoma kinase (EML4-ALK) gene mutation, crizotinib was initiated.
• The patient maintained normal kidney function during initial diagnosis and first-line chemotherapy.

Findings:

• Crizotinib administration was associated with two distinct episodes of elevated serum creatinine levels.
• Urinalysis revealed a protein-to-creatinine ratio of 0.31 g/g with 22% albumin and macroscopic hematuria.
• Kidney biopsy confirmed acute tubular necrosis (ATN) with mononuclear cell infiltrate, indicating recent renal injury and ongoing repair, temporally linked to crizotinib treatment.

Implications:

• This case suggests a potential causative role for crizotinib in inducing acute kidney injury, specifically ATN.
• The described renal adverse event associated with crizotinib has not been previously documented.
• Further investigation is warranted to understand the mechanism and frequency of crizotinib-induced nephrotoxicity in NSCLC patients.