Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press188810.17650/1726-9776-2025-21-2-33-41DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиAssessment of kidney injury during immune-targeted therapy (pembrolizumab + axitinib) in patients with metastatic renal cell carcinoma and solitary kidneyОценка почечного повреждения на фоне иммунотаргетной терапии (пембролизумаб + акситиниб) у пациентов с метастатическим почечно-клеточным раком с единственной почкойhttps://orcid.org/0000-0003-4460-9136TitovK. S.ТитовК. С.
Russian Federation

5 2nd Botkinskiy Proezd, Moscow 125284; 6 Miklukho-Maklaya St., Moscow 117198

125284 Москва, 2-й Боткинский пр-д, 5; 117198 Москва, ул. Миклухо-Маклая, 6

https://orcid.org/0000-0002-8398-7255EpifanovaM. V.ЕпифановаМ. В.

6 Miklukho-Maklaya St., Moscow 117198

117198 Москва, ул. Миклухо-Маклая, 6

https://orcid.org/0009-0003-4479-683XAlimovA. A.АлимовA. А.

Artemiy Andreevich Alimov

5 2nd Botkinskiy Proezd, Moscow 125284; 6 Miklukho-Maklaya St., Moscow 117198

Артемий Андреевич Алимов 

125284 Москва, 2-й Боткинский пр-д, 5; 117198 Москва, ул. Миклухо-Маклая, 6

alimov.oncologist@gmail.comhttps://orcid.org/0000-0002-1213-8600ShutovE. V.ШутовЕ. В.

5 2nd Botkinskiy Proezd, Moscow 125284; Build. 1, 2/1 Barrikadnaya St., Moscow 12599

125284 Москва, 2-й Боткинский пр-д, 5; 125993 Москва, ул. Баррикадная, 2/1, стр. 1

shutov_e_v@mail.ruhttps://orcid.org/0000-0003-3355-4547NesterovaO. Yu.НестероваО. Ю.

1 Leninskie Gory, Moscow 119991

119991 Москва, Ленинские горы, 1

https://orcid.org/0000-0001-5366-1281LebedevS. S.ЛебедевС. С.

5 2nd Botkinskiy Proezd, Moscow 125284; Build. 1, 2/1 Barrikadnaya St., Moscow 12599

125284 Москва, 2-й Боткинский пр-д, 5; 125993 Москва, ул. Баррикадная, 2/1, стр. 1

https://orcid.org/0000-0003-2347-4615ZapirovG. M.ЗапировГ. Н.

6 Miklukho-Maklaya St., Moscow 117198

117198 Москва, ул. Миклухо-Маклая, 6

S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare DepartmentГБУЗ г. Москвы «Московский многопрофильный научно-клинический центр им. С.П. Боткина Департамента здравоохранения г. Москвы»Peoples’ Friendship University of Russia named after Patrice LumumbaФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииM.V. Lomonosov Moscow State UniversityФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова»0608202521233410601202522062025https://oncourology.abvpress.ru/oncur/article/view/1888

Aim. To assess the rate and type of kidney injury in the first 28 weeks of pembrolizumab and axitinib therapy after nephrectomy in patients with metastatic renal cell carcinoma and solitary kidney.

Materials and methods. The retrospective study included 50 patients who previously underwent nephrectomy due to stage III–IV stage renal cell carcinoma. After nephrectomy prior to the start of antitumor therapy for cancer progression, 84 % of the patients were diagnosed with stage II and higher chronic kidney disease.

Results. During antitumor drug treatment, acute kidney injury 14 and 28 weeks after the start of immune-targeted therapy was diagnosed in 4 % and 6 % of patients, respectively. Dynamics of the change in acute kidney injury in 28 weeks were not statistically significant (p = 0.983). Changes in serum creatinine, urea, and glomerular filtration rate were also insignificant. Statistically significant elevation of hemoglobin and hematocrit was observed during the 28 weeks of observation. Hemoglobin level increased from 128.1 g/L before the treatment to its maximal value of 141.7 g/L after the third injection of pembrolizumab (p <0.001).

Conclusion. No significant kidney injury was observed during 28 weeks of observation in this single cohort study of patients with metastatic renal cell carcinoma after nephrectomy receiving pembrolizumab and axitinib.

Цель исследования – оценить частоту и виды почечного повреждения в первые 28 нед на фоне иммунотаргетной терапии комбинацией пембролизумаб + акситиниб метастатического почечно-клеточного рака у пациентов с единственной почкой, которые ранее перенесли нефрэктомию по поводу основного заболевания.

Материалы и методы. В ретроспективное исследование были включены 50 пациентов, ранее перенесших нефрэктомию по поводу рака почки III–IV стадий. После нефрэктомии перед началом противоопухолевой лекарственной терапии по поводу прогрессирования рака почки у 84 % пациентов была диагностирована хроническая болезнь почек II стадии и выше.

Результаты. В ходе противоопухолевого лекарственного лечения острое почечное повреждение через 14 и 28 нед от начала иммунотаргетной терапии развилось у 4 и 6 % пациентов соответственно. Динамика изменения острого почечного повреждения на протяжении 28 нед лечения оказалась статистически незначимой (р = 0,983). При оценке динамики уровня креатинина его повышения на протяжении всего периода терапии не наблюдалось, а общая динамика в течение 28 нед была статистически незначимой. Статистически значимые изменения уровня мочевины и скорости клубочковой фильтрации также отсутствовали. На протяжении 28 нед терапии отмечалось статистически значимое повышение уровней гемоглобина и гематокрита. Так, до начала терапии средний уровень гемоглобина в общей выборке пациентов составлял 128,1 г/л, в то время как после 3-го введения препаратов отмечалось максимальное его повышение до 141,7 г/л (р <0,001).

Заключение. В настоящей когорте пациентов с метастатическим раком почки на фоне терапии комбинацией пембролизумаб + акситиниб, ранее перенесших нефрэктомию, не отмечалось выраженного почечного повреждения в течение всего периода наблюдения.

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