Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy

Area of Science:

• Oncology
• Nephrology
• Endocrinology

Background:

• Novel immunotherapies, including immune checkpoint inhibitors (ICIs) and chimeric antigen receptor (CAR) T cells, are revolutionizing cancer treatment across various malignancies.
• Immune-related adverse events (irAEs) are common with these therapies, with acute kidney injury (AKI) being a frequent renal complication.

Purpose of the Study:

• This review aims to elucidate the spectrum of electrolyte disorders associated with modern cancer immunotherapies.
• To highlight the mechanisms and clinical presentations of these novel irAEs.

Main Methods:

• Comprehensive literature review focusing on immunotherapy-associated electrolyte disturbances.
• Analysis of reported cases and mechanisms linking ICIs and CAR T-cell therapy to specific electrolyte abnormalities.

Main Results:

• Immune checkpoint inhibitors are frequently associated with hyponatremia, primarily via the syndrome of inappropriate antidiuresis.
• Other ICI-related findings include hypokalemia (linked to renal tubular acidosis), hypercalcemia (due to PTHrP production or granulomas), and hypocalcemia/hyperphosphatemia (in tumor lysis syndrome).
• CAR T-cell therapy commonly causes hyponatremia and other electrolyte imbalances.

Conclusions:

• Immunotherapy-induced electrolyte disorders are diverse and mechanistically varied.
• Prompt identification and management are essential for optimizing patient care and mitigating potential complications from these novel cancer treatments.