Immune Checkpoint Inhibitors and the Kidney: A Focus on Diagnosis and Management for Personalised Medicine

Area of Science:

• Oncology
• Nephrology
• Immunology

Background:

• Immunity is vital for cancer control, yet tumors can evade immune surveillance, leading to progression and metastasis.
• Immune checkpoint inhibitors (ICIs) are emerging as effective anticancer therapies for advanced solid tumors.
• Adverse events, including immune-related adverse events (irAEs), are common with ICIs, necessitating careful management.

Purpose of the Study:

• To present a practical, multidisciplinary approach for managing renal toxicity in cancer patients undergoing ICI therapy.
• To consolidate current understanding of the mechanisms and clinical implications of ICI-induced nephrotoxicity.
• To guide clinicians in the timely recognition and effective treatment of kidney-related irAEs.

Main Methods:

• Review of current literature on immune checkpoint inhibitors and associated renal toxicity.
• Analysis of proposed mechanisms of ICI-induced kidney injury.
• Synthesis of clinical data and expert recommendations for patient management.

Main Results:

• Renal toxicity from ICIs, while infrequent, can manifest through various mechanisms and may necessitate treatment modifications.
• Early detection and intervention are crucial for managing ICI-related renal adverse events.
• Multidisciplinary collaboration involving oncologists, nephrologists, and pathologists is essential for optimal patient outcomes.

Conclusions:

• Effective management of ICI-induced renal toxicity requires a proactive and collaborative approach.
• Understanding the diverse mechanisms of nephrotoxicity aids in tailored treatment strategies.
• This review provides a framework for multidisciplinary teams to navigate the complexities of renal complications in cancer patients on ICIs.