Pembrolizumab
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Pembrolizumab C3 glomerulonephritis: case report
A 73-year-old man developed C3 glomerulonephritis during treatment with pembrolizumab for a non-small cell lung cancer (NSCLC). The man, who was a smoker (current smoker), was diagnosed with NSCLC with duodenal metastases. The tumour had a high PD-1 expression with no ALK genomic tumour aberrations or epidermal growth factor receptor. He was initiated on IV pembrolizumab 2 mg/kg every 21 days. After 3 cycles of pembrolizumab, he developed severe erythematous pruritic rash. Therefore, the man’s pembrolizumab therapy was discontinued despite an excellent tumour response. One month afterwards, he was referred for a diffuse swelling. He underwent several laboratory examinations. Haematuria was identified on dipstick. Owing to the acute kidney injury related to a nephrotic syndrome, he underwent a kidney biopsy. On light microscopy, one of the nine glomeruli was globally sclerotic. All the remaining glomeruli showed a typical pattern of membranoproliferative glomerulonephritis (MPGN) with lobular mesangial hypercellularity, endocapillary proliferation (mostly polynuclear neutrophils) and thickened capillary walls with double contours. Immunofluorescence study revealed intense glomerular deposits of C3 in the absence of remarkable immunoglobulin G, immunoglobulin M and C1q staining. A diagnosis of C3 glomerulonephritis was considered. Additional work-up revealed a decreased C3 level, increased C5b9 level and normal C4 level. Tests for anti-complement factor H, anti-factor B antibodies and C3 nephritic factor were negative; however, enzyme linked immunosorbent assay performed for antiC3b antibody was found to be positive. He was initiated on unspecified steroids, and his renal function improved rapidly. Ten days after the initiation of steroids, his serum creatinine decreased, and albuminemia and C3 level increased, while creatinuria/ proteinuria decreased. Two weeks later, he died due to a severe pulmonary infection. Ville S, et al. C3 glomerulonephritis in a patient treated with anti-PD-1 antibody. European Journal of Cancer 125: 46-48, Jan 2020. Available from: URL: https:// doi.org/10.1016/j.ejca.2019.11.011
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Reactions 11 Jan 2020 No. 1786
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