Monoclonal antibodies
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Proteinuria and proximal tubule lesions: case report A 48-year-old man developed proteinuria and proximal tubule lesions after receiving treatment with an antiintegrin monoclonal antibody [drug not stated] for nonsmall cell lung cancer. The man was involved in a clinical trial where he received an anti-integrin monoclonal antibody 30 mg/kg [frequency not stated], with carboplatin and paclitaxel, as well as a single dose of zoledronic acid for the management of hypercalcaemia. Fifteen days after the first cycle of the treatment, he developed grade 2 proteinuria. Laboratory tests revealed hyponatraemia, and low serum albumin and uric acid levels (29 g/L and 130 µmol/L, respectively). Normal levels of potassium, calcium, phosphates and creatinine were observed. A 24-hour urinary collection showed a proteinuria of 3g. A renal biopsy revealed signs of tubular damage with pre-necrotic lesions of epithelia. The proteinuria fell to grade 1 within a few days without specific treatment. The man was re-challenged with the same combination of three drugs at the same dosages, and a new increase of urinary proteins was detected 1 week later, but at a lower level of 1.6 g/L with 1.55g collected over 24 hours on day 15. He received two further cycles of the same chemotherapy with a reduced dose of 20 mg/kg of monoclonal antibody. The proteinuria resolved completely, however treatment was discontinued after four cycles due to disease progression. Author comment: "In conclusion we reported a case of renal damage, consisting of proteinuria and lesion preceding tubular necrosis, related to anti-integrin monoclonal antibody, which is in early phases of clinical development." Gombos A, et al. Proteinuria and proximal tubule lesions induced by an antiintegrin monoclonal antibody treatment: Case report. Investigational New Drugs 28: 102-105, No. 1, Feb 2010. Available from: URL: http://dx.doi.org/10.1007/ 803007657 s10637-009-9247-3 - France
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Reactions 20 Mar 2010 No. 1293
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