# Early Acute Kidney Injury and Its Association With Survival in Patients With Metastatic Non‐Small‐Cell Lung Cancer Treated With Front‐Line Immunotherapy‐Based Therapies

## TL;DR

Early kidney injury in lung cancer patients treated with immunotherapy is linked to worse survival, especially when using certain drug combinations.

## Contribution

Identifies a novel association between early acute kidney injury and reduced survival in metastatic NSCLC patients treated with pembrolizumab-based regimens.

## Key findings

- Early AKI was associated with a 1.733 hazard ratio for death within 12 months.
- The highest AKI rate was observed in patients receiving pemetrexed, pembrolizumab, and carboplatin.
- AKI recovery did not significantly affect 12-month survival rates.

## Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized metastatic NSCLC treatment. Acute kidney injury (AKI) is a common complication of ICI‐based therapies, alone or with chemotherapy. This study investigates the association between early AKI and 12‐month survival among patients with metastatic NSCLC receiving front‐line ICI‐based treatment.

This retrospective study included metastatic NSCLC patients who received ICI‐based therapy (2017–2022). Early AKI was defined as a creatinine increase ≥ 1.5 times baseline within 21 days of the fourth cycle or last cycle if fewer than four were given. Clinical characteristics were compared using t‐tests and chi‐squared tests. Survival differences were assessed by Kaplan–Meier and log‐rank tests, with Cox models evaluating the association between AKI and 12‐month survival.

Of the 310 patients, AKI occurred in 38 patients (12.6%), with 8 patients (2.3%) missing follow‐up creatinine data. The hazard ratio (HR) for death within 12 months for patients who developed early AKI was 1.733 (95% CI 1.060–2.835, p = 0.026). The highest rate of early AKI was seen in patients receiving pemetrexed, pembrolizumab, and carboplatin (16.7%), compared to 11.1% for pembrolizumab monotherapy and 4.5% for pembrolizumab with paclitaxel and carboplatin. Although patients who recovered renal function were more likely to continue immunotherapy, 12‐month survival rates did not significantly differ (52.2% vs. 46.7%).

Early AKI during pembrolizumab‐based treatment in metastatic NSCLC patients was associated with reduced 12‐month survival. These findings highlight the need for close monitoring and preventive strategies to manage AKI in this population.

Early acute kidney injury (AKI) in metastatic NSCLC patients treated with pembrolizumab‐based regimens was associated with reduced survival within the first 12 months of treatment, with the highest AKI rates observed in patients receiving combination regimens with pemetrexed and carboplatin. This underscores the critical need for effective monitoring and preventive strategies to manage AKI and for studies to evaluate the etiology and biology of the association between AKI and cancer outcomes.