A multi-center clinical trial is underway to identify a biomarker for acute interstitial nephritis, a kidney inflammation and injury stemming from cancer immunotherapy. The study, led by Yale School of Medicine's Dr. Dennis Moledina, seeks to improve the diagnosis and management of acute kidney injury in patients undergoing cancer immunotherapy, potentially preventing unnecessary treatment interruptions and permanent kidney damage.
The Challenge of Acute Kidney Injury in Immunotherapy
Immune checkpoint inhibitors, a revolutionary class of cancer drugs, carry the risk of triggering immune reactions that can affect various organs, including the kidneys. According to Dr. Moledina, approximately one in five patients receiving cancer immunotherapy develops acute kidney injury within the first year. Determining whether this injury is due to checkpoint nephritis—an immune reaction to the checkpoint inhibitors—or other factors is crucial for guiding cancer treatment.
The Role of CXCL9 as a Biomarker
The study focuses on the biomarker CXCL9 to distinguish checkpoint nephritis from other causes of acute kidney injury. Acute kidney injury, characterized by a rise in creatinine levels in the blood, can result from various factors, such as dehydration or infection. Misdiagnosing checkpoint nephritis can lead to unnecessary steroid therapy and pauses in immunotherapy, potentially allowing cancer to progress. Conversely, missing checkpoint nephritis can result in permanent kidney damage and ineligibility for chemotherapy.
Study Design and Expected Outcomes
The clinical trial, enrolling patients who develop acute kidney injury at Yale, Johns Hopkins, Brigham and Women’s Hospital, and Mass General Hospital, will assess whether CXCL9 can effectively differentiate checkpoint nephritis from other causes of acute kidney injury. The researchers envision a future where a urine test for CXCL9 can rapidly identify checkpoint nephritis, enabling prompt treatment with prednisone or other immunosuppressive therapies to minimize interruptions in cancer immunotherapy. Conversely, low CXCL9 levels would indicate alternative causes of acute kidney injury, allowing for appropriate treatment without disrupting cancer therapy.
Improving Care for Cancer Patients
The ultimate goal of the study is to enable patients with acute kidney injury to continue receiving cancer immunotherapy with minimal interruption. By accurately diagnosing the cause of acute kidney injury, clinicians can tailor treatment strategies to optimize both cancer control and kidney function.
