Topic Discussion: Tumor Lysis Syndrome with immunotherapy

At this point the nephrology and oncology community is very aware of the AIN, glomerular diseases including vasculitis and ATN seen with check point inhibitors… but we might not be aware of tumor lysis syndrome that this drug can entice in certain patients. 

In the last 2 years, I found several published reports of TLS with check point inhibitors.

Here is a table I created to help with the theme on this one

Immunotherapy	Age	Gender	Cancer type	Time to TLS	Dialysis needed?	Outcome	Reference
Nivolumab	76	Male	Melanoma	5	Yes but declined	Disease progression-death	http://www.alliedacademies.org/articles/acute-tumor-lysis-syndrome-after-antipd1-immunotherapy-nivolumab-for-metastatic-melanoma-8038.html
Atezolizumab	77	Female	GU cancer	14	Yes	Disease progression-death	http://www.acanceresearch.com/cancer-research/tumor-lysis-syndrome-following-a-single-atezolizumab-infusion-for-metastatic-urothelial-carcinoma-involving-both-upper-and-lower-t.php?aid=18193
Atezolizumab	-	-	Solid tumor	-	-	-	https://www.ncbi.nlm.nih.gov/pubmed/25428504
Atezolizumab	-	-	Solid tumor	-	-	-	https://www.ncbi.nlm.nih.gov/pubmed/25428504
Ipilumumab	73	Male	Melanoma	6	No	Death	https://www.ncbi.nlm.nih.gov/pubmed/27256718
Nivolumab	74	Male	RCC	2	No	Death	https://medcraveonline.com/JCPCR/JCPCR-08-00271.php

Based on this, it is seen with PD-1, PDL1 and CTLA4 inhibitors and melanoma and urological cancers. A recent review in JON showed a case of a patient getting TLS with melanoma.  So it’s hard to tell if these agents are causing it or is it the burden of tumor- usually solid tumors in these cases.