1181 Association between developing acute renal failure and one-year survival in patients with metastatic NSCLC who have received immune checkpoint inhibitor-based front-line treatment

<h3>Background</h3> Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of metastatic non-small cell lung cancer (NSCLC). Acute kidney injury (AKI) is a common complication for patients undergoing ICI-based treatment, whether used alone or in combination with chemotherapy, such as pemetrexed. We investigated the association between early AKI development and 1-year survival in patients with metastatic NSCLC who received front-line ICI-based treatment. <h3>Methods</h3> This retrospective study included 248 patients without actionable mutation who initiated ICI-based therapy between 2017 and 2021 at the Ohio State University. AKI was defined as an elevation in creatinine ≥1.5 times the baseline, attributable to any cause, from the start of treatment until 21 days after the fourth treatment cycle or until the end of the last cycle if patients received fewer than four cycles. Clinical characteristics were summarized and compared between the AKI and non-AKI groups using two-sample t-tests for continuous variables and chi-squared tests for categorical variables. Comparison between patients with and without AKI using Kaplan-Meier plots and reported the log-rank p-value for statistical significance. Additionally, Cox proportional hazard models were used to examine the relationship between AKI and survival up to 12 months in multivariate analysis. <h3>Results</h3> Of 248 patients, 33 (13.3%) developed AKI (table 1). Of 103 patients who received pembrolizumab monotherapy, 11 (10.7%) developed AKI. Among the 115 patients treated with pemetrexed, pembrolizumab, and carboplatin, 20 (17.4%) developed AKI. Additionally, 2 (6.67%) of the 30 patients who received paclitaxel with pembrolizumab and carboplatin also developed AKI. Patients who received immunochemotherapy containing pemetrexed had a higher rate of AKI, but the difference was not statistically significant (p=0.180). Patients who experienced early AKI had a significantly lower one-year survival probability of 51.5% compared with 65.6% for those who did not develop AKI (p=0.032, figure 1). After adjusting for performance status and type of treatment, the association remained significant: Patients with AKI had a 72% higher risk of death within the first year compared to those without AKI, with an adjusted hazard ratio of 1.72 (95% CI: 1.00–2.97, p=0.05). <h3>Conclusions</h3> Patients with metastatic NSCLC who experienced early AKI from any cause during ICI-based treatment exhibited a significantly higher hazard ratio of death within the first year of initiating treatment. These findings underscore the need for increased attention to this patient population. Additionally, a larger cohort and detailed analysis of the root causes of AKI are necessary to clarify these relationships further. <h3>Acknowledgements</h3> This study was supported by the National Institutes of Health (P30CA016058). Research support provided by the REDCap project and The Ohio State University Center for Clinical and Translational Science grant support (National Center for Advancing Translational Sciences, Grant UL1TR002733). <h3>Ethics Approval</h3> This study was approved by the institutional review board at the Ohio State University (IRB 2018C0177).