Renal-limited ANCA-associated vasculitis during erlotinib treatment for lung carcinoma
Rikako Oki1, Yosuke Hirakawa2, Yasuhiro Oda1
1Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Abstract:
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) had clinical success in the treatment of non-small cell lung carcinoma (NSCLC). An effect of this drug on kidney has not been clarified and the occurrence of glomerulonephritis related to EGFR-TKI has rarely been reported. We present the case of a 71-year-old man with NSCLC who developed proteinuria and microscopic hematuria with the rise in a titer of MPO-ANCA, when 2 years and 3 months passed since the initiation of erlotinib, one of oral EGFR-TKI. Two serial biopsies support that ANCA-associated vasculitis may have been modified by the persistent use of erlotinib. We initiated intravenous pulse therapy with methylprednisolone followed by oral prednisone. The proteinuria has decreased and serum CRP was normalized. However, the serum creatinine level and hematuria did not change during the treatment period. While EGFR inhibition is implicated in protective control for glomerulonephritis, it may exacerbate vasculitis. Close monitoring of the kidney function and urinary findings is required during the use of EGFR inhibitors, such as erlotinib, because it may cause renal adverse events.
Insights
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) treat non-small cell lung carcinoma (NSCLC). Erlotinib, an EGFR-TKI, may exacerbate ANCA-associated vasculitis, causing kidney issues like proteinuria and hematuria.
Area of Science:
- Nephrology
- Oncology
- Rheumatology
Background:
- Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective in treating non-small cell lung carcinoma (NSCLC).
- The renal effects of EGFR-TKIs are not fully understood, with rare reports of glomerulonephritis.
- ANCA-associated vasculitis (AAV) is a systemic autoimmune disease affecting small blood vessels.
Observation:
- A 71-year-old man with NSCLC developed proteinuria and microscopic hematuria after 2 years of erlotinib treatment.
- His MPO-ANCA titer increased, suggesting a link to ANCA-associated vasculitis.
- Renal biopsies indicated that erlotinib might have modified the course of AAV.
Findings:
- Erlotinib treatment was associated with the development of proteinuria, hematuria, and elevated MPO-ANCA titers.
- While corticosteroid therapy reduced proteinuria and normalized CRP, serum creatinine and hematuria remained unchanged.
- The findings suggest a potential exacerbation of ANCA-associated vasculitis by erlotinib.
Implications:
- EGFR inhibition may have a dual role in kidney disease, potentially protecting against glomerulonephritis but exacerbating vasculitis.
- Close renal monitoring is crucial for patients receiving EGFR inhibitors like erlotinib due to potential adverse events.
- This case highlights the need for awareness of rare renal complications associated with targeted cancer therapies.
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