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Acute kidney injury: case report A 67-year-old woman developed acute kidney injury during therapy with dabrafenib, trametinib and pembrolizumab [dosages, routes and duration of treatment to reaction onset not stated]. The woman, who had a history of a resected dysplastic nevus of the chest wall presented with a painless axillary lump and was diagnosed with melanoma. Her targeted sequencing of BRAF revealed a typical BRAFV600E mutation. She was initially treated with ipilimumab and bevacizumab. However, her disease progression was noticed after 2 months. A pathologic humerus fracture also seen. Her therapy was switched to (RMi) therapy with dabrafenib and trametinib that showed significant response. After 16 months, a CT of the torso showed persistent disease involving the spleen and liver. Hence, pembrolizumab was initiated. However, 10 days after the first infusion of pembrolizumab, she experienced exertional dyspnoea, bilateral lower extremity oedema and weight gain. Laboratory tests showed elevated serum creatinine, blood urea nitrogen was 41 mg/dL and the tests also showed hyponatremia. Thus, a diagnosis of acute kidney injury was made. Her volume overload was considered secondary to acute kidney injury. She also experienced a newly elevated NT-pro-BNP. Her trans-thoracic echocardiography revealed normal left ventricular ejection fraction of 55%, and there was no evidence of diastolic dysfunction. Liver function tests were normal. Her urine electrolytes demonstrated a fractional excretion of sodium of 5.3%, and trace granular casts were seen by urinalysis and urine sedimentation. Later, her hyponatremia was thought to be secondary to syndrome of inappropriate antidiuretic hormone, along with a possible additional contribution of intrinsic renal failure. The woman was hospitalised, and her RMi therapy (dabrafenib and trametinib) was stopped. She was treated with furosemide and was placed on water restriction. However, her creatinine increased, which raised the concern for progressive renal failure. Hence, an empiric trial of prednisone was initiated. Following initiation of prednisone, a sharp decline in the serum creatinine level was observed in 48 hours. Thereafter, she was discharged on prednisone. After a week, during the follow up, a significant improvement was noted. She continued prednisone therapy for 4 weeks at tapering doses. Three weeks after the discharge, she was re-started on dabrafenib and trametinib therapy. Her serum creatinine and sodium levels normalised over 2 months. She continued RMi therapy without any complications. Thummalapalli R, et al. Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors. 803518074 Melanoma Research 30: 219-222, No. 2, Apr 2020. Available from: URL: http://doi.org/10.1097/CMR.0000000000000646

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Reactions 28 Nov 2020 No. 1832