Background: In Keynote 189, an increased incidence of renal toxicity was observed with combination platinum-pemetrexed-pembrolizumab (PPP) therapy compared to chemotherapy alone. Studies have shown that compared to White Americans, Black Americans are at higher risk of morbidity and mortality associated with chronic kidney disease (CKD). We conducted a retrospective analysis of patients treated with PPP to assess the rate of renal toxicity in Black and White patients.
Methods: Data of self-identified non-hispanic (NH) Black and NH White patients with advanced NS-NSCLC who were treated with PPP between January 1, 2017, and November 1, 2020, at the Henry Ford Health System was analyzed. Serum creatinine (Cr) and calculated glomerular filtration rate (GFR) before the first cycle of PPP and over the duration of PPP therapy were assessed. Acute kidney injury (AKI) was defined as an increase in Cr 1.5 times the baseline value. Reduction in GFR of ≥ 30% was considered significant. Multiple variables and outcomes were analyzed by two-group comparisons, univariate analysis, and Cox regression.
Results: A total of 134 patients were included in the analysis. The mean age was 66.5 (SD 8.6) years, and 65 (48.5%) patients were men. A total of 33 (24%) patients were NH Black and 101 (75.4%) were NH White. There were 10 (8.1%) patients who developed AKI, and the median time to development of AKI was 4.5 months. No significant association of Black (3) or White (7) ethnicity with AKI was observed (p =.57). The odds of developing AKI was not increased in patients with a history of hypertension (p =.67), diabetes mellitus (p =.33), cardiovascular disease (p =.68), or CKD (p =.33). A total of 17 out of 127 (13.4%) patients had significantly reduced GFR, and patients with CKD were more likely to have reduced GFR (OR 4.8, p =.02). At the median follow-up of 24.5 months, the median survival was 15.2 months (95% CI, 12.7-22.2). Black ethnicity (HR 1.21, p =.46) and development of AKI (HR 1.13; 95% CI, 0.45–2.86) were not associated with increased mortality.
Conclusions: Black patients with NS-NSCLC treated with PPP are not at higher risk of AKI or death than White patients. Development of AKI after PPP therapy was not associated with increased mortality
