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BMC Cancer. 2016 Aug 19;16:656. doi: 10.1186/s12885-016-2718-y.

Pembrolizumab-associated minimal change disease in a patient with malignant pleural mesothelioma.

Author information

1
Department of Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. angelika.bickel@kssg.ch.
2
Division of Nephrology and Transplantation Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.
3
Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
4
Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
5
Department of Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.

Abstract

BACKGROUND:

Pembrolizumab is an anti- Programmed Death 1 (PD-1) antibody approved in melanoma, non-small cell lung cancer and investigated in malignant pleural mesothelioma. The most frequent immunotherapy related autoimmune reactions include dermatitis, pneumonitis, colitis, hypophysitis, uveitis, hypothyreodism, hepatitis and interstitial nephritis.

CASE PRESENTATION:

We describe a 62-year old patient diagnosed with malignant pleural mesothelioma who experienced ten days after the second dose of third line therapy with pembrolizumab sudden onset of generalized edema including legs and eyelids and weight gain of 15 kg resulting from nephrotic syndrome and acute renal failure. Pembrolizumab was discontinued and prednisone, diuretics and angiotensin II receptor blocker were initiated with full recovery of symptoms and renal function. Pembrolizumab-associated minimal change disease (MCD) was confirmed by electron microscopy in the renal biopsy.

CONCLUSION:

We are the first to describe pembrolizumab-related minimal change disease (MCD). Physicians should be aware of this side effect in patients presenting with edema and weight gain and initiate prompt renal function testing, serum albumin and urinalysis followed by steroid treatment if pembrolizumab-related MCD is suspected.

KEYWORDS:

Immunotherapy; Malignant Pleural Mesothelioma; Minimal change disease; PD-1 antibody; Pembrolizumab

PMID:
27543082
PMCID:
PMC4992260
DOI:
10.1186/s12885-016-2718-y
[Indexed for MEDLINE]
Free PMC Article

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