Safety and Efficacy of Immune Checkpoint Inhibitors for End-stage Renal Disease Patients Undergoing Dialysis - Beyond the Abstract

According to pharmacokinetic data in clinical trials, toxicity and efficacy of immune checkpoint inhibitor (ICIs) are not dose-dependent, and ICIs can be used without dose adjustment in patients with renal dysfunction. However, patients with a glomerular filtration rate below 30 could not be registered in clinical trials, and there is no data of pharmacokinetics, safety and efficacy in end-stage renal disease (ESRD).

In this study, we showed 3 patients who were administrated ICIs on dialysis. These patients showed various responses and one of them experienced immune-related pneumonitis. Currently, there are only a few case reports about ICIs on ESRD patients, and our report is the first largest report. We comprehensively reviewed all published cases that we could find and analyzed them for identifying the tendency of tumor response and an adverse event. This study suggested that the ESRD on dialysis may not be a contraindication for the use of the ICIs, and some patients can benefit from the ICI.

Written By: Bhumsuk Keam, MD, Ph.D., Clinical Associate Professor, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea