Tumor Lysis Syndrome in patient with metastatic renal pelvis urothelial carcinoma, Associated with Nivolumab: a case report
Allen Yu Ting Lin, Yu-Ching Wen, Liang-Ming Lee, Ke-Hsun Lin,Yung-Wei Lin, Hung-Jen Shih, Chi-Hao Hsiao
Department of Urology, Wan Fan Hospital, Taipei Medical University, Taipei, Taiwan
Purpose: We presenting a case of tumor lysis syndrome related to Immune-checkpoint blocking antibodies programmed death ligand-1 (PD-L1) inhibitor therapy for urothelial carcinoma patient.
Case: An 85 year-old female with urothelial carcinoma with post-operation extensive liver and lung metastasis and high PD-L1 immunohistochemical stain developed tumor lysis syndrome on the second course of Nivolumab therapy, which present with acute kidney with hyperuricemia and hyperkalemia.
Discussion: Nivolumab, a fully human IgG4 anti-PD-1 antibody that selectively blocks the interaction between PD-1 and its ligand was noted for its clinical benefit and fair tolerability for the treatment to solid tumor. However, aggressive treatment might be necessary for Nivolumab induced major adverse event such as Tumor lysis syndrome. Patient with features like bulky disease, extensive liver involvement, elevated LDH, elevated uric acid, elevated creatinine, and acute onset of disease with clinical evidence of rapid growth might be warrant for additional care
Conclusions: Tumor lysis syndrome associated with checkpoint blocking immunotherapy in solid tumor can be life-threatening. Optimal use of these agents requires prompt recognition and management of immune-mediated toxicities. The finding of this study is the first case to report tumor lysis syndrome associated with Nivolumab for renal pelvis urothelial carcinoma with liver and lung metastasis.