Atezolizumab
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Acute kidney injury and immune thrombocytopenic purpura: case report A 57-year-old woman developed acute kidney injury (AKI) and immune thrombocytopenic purpura (ITP) during treatment with atezolizumab for non-small cell lung cancer (NSCLC). The woman, who had been receiving treatment with atezolizumab [route not stated] 1200mg every 3 weeks as a third-line treatment for metastatic lung adenocarcinoma, hospitalised with 1 week history of fatigue and back pain. She had developed fatigue and back pain after 1 week of initiation of atezolizumab. She had a history of lung lobectomy for NSCLC. She had received treatment with paclitaxel-cisplatin protocol, following which, after approximately a year, she had developed metastasis. Then she had received vinorelbine-cisplatin, followed by docetaxel-carboplatin therapy after disease progression. Additionally, she had a history of Hashimoto thyroiditis for 12 years. She had no alcohol history; however, she smoked 38 packs/year cigarette, but she had stopped smoking for the last 2.5 years. Subsequent physical examination after admission showed pallor mucosae, while other examinations were normal. Blood test showed blood urea nitrogen (BUN) of 27 mg/dL, creatinine 2.9 mg/dL, total bilirubin 2 mg/dL, direct bilirubin 0.38 mg/dL and lactate dehydrogenase (LDH) 292 U/L. In complete blood count (CBC), isolated thrombocytopenia (19 x 103/mL) was noted. Urine analysis demonstrated 2 proteins (protein/creatinine ratio 640 mg/g) and RBC 169 per/hpf. Subsequent Coombs test, hepatitis markers, antinuclear antibody, anti-neutrophil cytoplasmic antibody were negative, while platelet count was consistent with total blood count. Anamnesis revealed that, prior to the initiation of atezolizumab, her baseline biochemical and haematological results included: BUN 12 mg/dL, creatinine 0.7 mg/dL, total/direct bilirubin 1/0.1 mg/dL, LDH 235 U/L, platelets 210 x 103/mL. Other CBC parameters and complete urine analysis results were also normal. Based on these findings, she was diagnosed with AKI and ITP. The Naranjo adverse drug reaction was probable with score of 8. The woman was therefore initiated with immune-globulin [immunoglobulin] (IVIG) and platelet apheresis due to haematuria, and methylprednisolone. Additionally, she received intravenous hydration. On the third day after the treatment, her platelet count normalised (310 x103/mL), creatinine decreased (1.5 mg/dL), and her symptoms improved. The methylprednisolone treatment was continued for 3 weeks, which was gradually reduced and stopped. During this time, IV hydration was continued. During the treatment period, thrombocytopenia did not recur. The creatinine gradually decreased and finally returned to normal levels (0.7 mg/dL). Thereafter, she had been receiving nivolumab with normal CBC, serum biochemistry and complete urine parameters. No AKI or ITP noted in follow-up period. Yilmaz A, et al. Possible atezolizumab-associated acute kidney injury and immune thrombocytopenia. Journal of Oncology Pharmacy Practice 26: 1791-1794, No. 7, Oc
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