Truth or dare: switching BRAF/MEK inhibitors after acute interstitial nephritis in a patient with metastatic melanoma - A case report and review of the literature.

IF 1.6 4区 医学 Q2 Medicine Acta Clinica Belgica Pub Date : 2023-06-01 DOI:10.1080/17843286.2022.2114684
Lore De Ryck, Sigurd Delanghe, Celine Jacobs, Sharareh Fadaei, Lieve Brochez, Michael Saerens
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引用次数: 1

Abstract

Introduction: The introduction of BRAF/MEK inhibitors has significantly improved overall survival of patients with BRAF V600-mutant advanced or metastatic melanoma. Most patients treated with BRAF/MEK inhibitors will experience adverse events during the course of their treatment. Kidney impairment, however, was rarely reported in the pivotal trials. To date, there are only three cases of biopsy-proven acute interstitial nephritis associated with dabrafenib and trametinib reported in the literature.

Case report: A 50-year-old man diagnosed with metastatic melanoma was hospitalized in August 2021, 5 months after treatment initiation with dabrafenib and trametinib. He presented with acute kidney injury, with serum creatinine of 3.34 mg/dL and eGFR of 20.3 mL/min/m². Kidney biopsy revealed acute interstitial nephritis.

Management & outcome: He was treated with methylprednisolone 16 mg qd, and both dabrafenib and trametinib were permanently discontinued, with recuperation of his kidney function. Another BRAF/MEK inhibitor combination, encorafenib and binimetinib, was introduced, with preserved kidney function and excellent disease control.

Discussion: We report the first case of biopsy-proven interstitial nephritis in a patient treated with dabrafenib and trametinib, with successful introduction of another BRAF/MEK inhibitor combination. Although rare, clinicians should be aware of the risk of renal adverse events associated with BRAF/MEK inhibitors. Renal biopsy is mandatory in the absence of a clear explanation or rapid recovery of renal failure. In case of proven interstitial nephritis, corticosteroids should be initiated. Switching to another BRAF/MEK inhibitor combination can be considered for patients with complete recovery of renal function and limited treatment options.

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真心话大冒险:转移性黑色素瘤患者急性间质性肾炎后切换BRAF/MEK抑制剂-一例报告和文献回顾
BRAF/MEK抑制剂的引入显著提高了BRAF v600突变晚期或转移性黑色素瘤患者的总生存率。大多数接受BRAF/MEK抑制剂治疗的患者在治疗过程中都会出现不良事件。然而,在关键试验中很少有肾损害的报道。迄今为止,文献中仅报道了3例经活检证实的急性间质性肾炎与达非尼和曲美替尼相关。病例报告:一名被诊断为转移性黑色素瘤的50岁男性于2021年8月住院,在开始使用达非尼和曲美替尼治疗5个月后。患者表现为急性肾损伤,血清肌酐3.34 mg/dL, eGFR 20.3 mL/min/m²。肾活检显示急性间质性肾炎。治疗和结果:患者接受甲基强的松龙16 mg qd治疗,并永久停用达非尼和曲美替尼,肾功能恢复。另一种BRAF/MEK抑制剂组合,恩科非尼和比尼美替尼,被引入,保留肾功能和良好的疾病控制。讨论:我们报告了第一例活检证实的间质性肾炎患者,该患者接受达非尼和曲美替尼治疗,并成功引入了另一种BRAF/MEK抑制剂组合。尽管罕见,临床医生应该意识到与BRAF/MEK抑制剂相关的肾脏不良事件的风险。肾活检是强制性的,在没有明确的解释或快速恢复肾功能衰竭。如果确诊为间质性肾炎,应开始使用皮质类固醇。对于肾功能完全恢复且治疗选择有限的患者,可以考虑改用另一种BRAF/MEK抑制剂组合。
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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