Renal-limited ANCA-associated vasculitis during erlotinib treatment for lung carcinoma.

Abstract

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) had clinical success in the treatment of non-small cell lung carcinoma (NSCLC). An effect of this drug on kidney has not been clarified and the occurrence of glomerulonephritis related to EGFR-TKI has rarely been reported. We present the case of a 71-year-old man with NSCLC who developed proteinuria and microscopic hematuria with the rise in a titer of MPO-ANCA, when 2 years and 3 months passed since the initiation of erlotinib, one of oral EGFR-TKI. Two serial biopsies support that ANCA-associated vasculitis may have been modified by the persistent use of erlotinib. We initiated intravenous pulse therapy with methylprednisolone followed by oral prednisone. The proteinuria has decreased and serum CRP was normalized. However, the serum creatinine level and hematuria did not change during the treatment period. While EGFR inhibition is implicated in protective control for glomerulonephritis, it may exacerbate vasculitis. Close monitoring of the kidney function and urinary findings is required during the use of EGFR inhibitors, such as erlotinib, because it may cause renal adverse events.

• Authors: Rikako Oki, Yosuke Hirakawa, Yasuhiro Oda, Motonobu Nakamura, Kenjiro Honda, Hiroyuki Abe, Yukako Domoto, Naoya Miyashita, Takahide Nagase, Masaomi Nangaku
• Journal: CEN case reports (CEN Case Rep) Vol. 11 Issue 1 Pg. 67-72 (02 2022) ISSN: 2192-4449 [Electronic] Japan
• PMID: 34309804 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2021. Japanese Society of Nephrology.

Chemical References

• Protein Kinase Inhibitors
• Erlotinib Hydrochloride
• ErbB Receptors

Topics

• Aged
• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (chemically induced, diagnosis, drug therapy)
• Carcinoma (drug therapy)
• Carcinoma, Non-Small-Cell Lung (drug therapy, pathology)
• ErbB Receptors
• Erlotinib Hydrochloride (adverse effects)
• Female
• Glomerulonephritis (chemically induced, diagnosis, drug therapy)
• Hematuria (chemically induced)
• Humans
• Kidney (pathology)
• Lung
• Lung Neoplasms (drug therapy, pathology)
• Male
• Protein Kinase Inhibitors (adverse effects)
• Proteinuria (drug therapy)