Table 1.

Benefits versus risks of drug rechallenge in patients with prior immune checkpoint inhibitor–associated acute kidney injury

Benefits of RechallengeRisk of Rechallenge
Data suggest risk of recurrence 7%–20%, on par with or better than AKI recurrence rates for other oncology drugs, including platinum drugsRecurrence of AKI, including >Grade 3
Risk-minimizing strategies exist: class switching, prophylactic corticosteroidsSide effects of prophylactic corticosteroids
Potential for increased progression-free survival and overall mortality with ongoing use of immunotherapyWith recurrent AKI, options down the line for other therapy (including targeted small molecules and chemotherapy) may be limited
Avoidance of other therapy with greater nephrotoxic potentialPotential need for RRT with severe AKI
Apart from irAEs, better side effect profile of immunotherapyHealthcare system burden with potential increase in severe AKI requiring RRT
No dose adjustments for patients with CKD (or ESKD)Recurrent AKI may lead to increased morbidity and mortality
Dosing schedule generally less frequent than chemotherapy, allowing improved QOL for patientsAKI may result in prolonged hospitalization, impeding on patients’ desire to be at home
  • irAE, immune-related adverse events; QOL, quality of life.