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Diffuse proliferative glomerulonephritis associated with cetuximab, an epidermal growth factor receptor inhibitor
Kotaro Sasaki1, Eric Anderson, Stuart J Shankland
1Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA. ksasaki@uw.edu
Insights
Cetuximab treatment for head and neck cancer may cause IgA-mediated glomerulonephritis. Discontinuation of cetuximab and treatment improved kidney function, suggesting a link.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Cetuximab, an epidermal growth factor receptor inhibitor, is used for advanced head and neck squamous cell carcinoma.
- Kidney complications are a potential concern with targeted cancer therapies.
Observation:
- A 67-year-old man developed acute renal failure and nephrotic-range proteinuria during cetuximab treatment for recurrent oral squamous cell carcinoma.
- Kidney biopsy revealed diffuse proliferative and crescentic glomerulonephritis with IgA-dominant immune deposits.
Findings:
- The patient's kidney function significantly improved after discontinuing cetuximab and receiving a short course of cyclophosphamide and steroids.
- This case suggests cetuximab may trigger or worsen IgA-mediated glomerular injury.
Implications:
- Close renal function monitoring is crucial for patients receiving cetuximab.
- Further research may elucidate the mechanisms linking EGFR inhibitors to IgA nephropathy.
Abstract:
Cetuximab is an epidermal growth factor receptor inhibitor used for advanced squamous cell carcinoma of the head and neck. We report an unusual case of diffuse proliferative and crescentic glomerulonephritis in a 67-year-old man in close temporal association with cetuximab treatment for recurrent oral squamous cell carcinoma. The patient presented with acute renal failure and nephrotic-range proteinuria. Kidney biopsy showed diffuse proliferative and focally crescentic glomerulonephritis associated with immunoglobulin A (IgA)-dominant immune-complex deposition within glomerular capillary walls and mesangium. The patient showed dramatic improvement in kidney function after discontinuation of cetuximab therapy and a short course of cyclophosphamide and steroid. The clinical outcome of this case suggests that cetuximab therapy may trigger or exacerbate IgA-mediated glomerular injury and warrants close monitoring of kidney function in patients treated with this epidermal growth factor receptor inhibitor.
