Proteinuria and influence on monoclonal antibody excretion: a pembrolizumab case report and literature review.

IF 0.7 Q4 UROLOGY & NEPHROLOGY
CEN Case Reports Pub Date : 2025-10-01 Epub Date: 2025-07-02 DOI:10.1007/s13730-025-01000-6
T S S Teuntje van Es, B J M Bas Peters, G Gurbey Ocak, E A Elisabeth Kastelijn, S L Sabine Croonen, F C Floris Loeff, M P H Marcel van den Broek
{"title":"Proteinuria and influence on monoclonal antibody excretion: a pembrolizumab case report and literature review.","authors":"T S S Teuntje van Es, B J M Bas Peters, G Gurbey Ocak, E A Elisabeth Kastelijn, S L Sabine Croonen, F C Floris Loeff, M P H Marcel van den Broek","doi":"10.1007/s13730-025-01000-6","DOIUrl":null,"url":null,"abstract":"<p><p>Therapeutic monoclonal antibodies (mAbs) have revolutionized the treatment landscape of various diseases, offering targeted therapy options with high specificity. Under normal physiological conditions, their size prevents renal excretion. However, there is limited information about mAbs pharmacokinetics in patients with massive proteinuria, a condition often associated with a nephrotic syndrome. In this case report, we describe a 68-year-old man with non-small-cell lung carcinoma (NSCLC) and a paraneoplastic nephrotic syndrome, who was treated with pembrolizumab 200 mg every 3 weeks. Since there is limited data on pembrolizumab disposition in patients with nephrotic syndrome, we monitored pembrolizumab serum and urine concentrations to ensure adequate systemic exposure. Therapeutic drug monitoring results showed no renal excretion of pembrolizumab and therapeutic drug exposure. Treatment of the NSCLC led to an amelioration of the paraneoplastic nephrotic syndrome. We conducted a literature review on the various types of proteinuria and their effects on the excretion of mAbs. Existing literature shows that increased renal clearance of monoclonal antibodies in patients with glomerular proteinuria is possible, but it probably depends on the amount of glomerular proteinuria. Based on literature findings and our own, we suggest that in cases of severe glomerular proteinuria, like nephrotic range proteinuria, the likelihood of renal loss of monoclonal antibodies is higher than in other cases.</p>","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":" ","pages":"757-763"},"PeriodicalIF":0.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457255/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CEN Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13730-025-01000-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/2 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Therapeutic monoclonal antibodies (mAbs) have revolutionized the treatment landscape of various diseases, offering targeted therapy options with high specificity. Under normal physiological conditions, their size prevents renal excretion. However, there is limited information about mAbs pharmacokinetics in patients with massive proteinuria, a condition often associated with a nephrotic syndrome. In this case report, we describe a 68-year-old man with non-small-cell lung carcinoma (NSCLC) and a paraneoplastic nephrotic syndrome, who was treated with pembrolizumab 200 mg every 3 weeks. Since there is limited data on pembrolizumab disposition in patients with nephrotic syndrome, we monitored pembrolizumab serum and urine concentrations to ensure adequate systemic exposure. Therapeutic drug monitoring results showed no renal excretion of pembrolizumab and therapeutic drug exposure. Treatment of the NSCLC led to an amelioration of the paraneoplastic nephrotic syndrome. We conducted a literature review on the various types of proteinuria and their effects on the excretion of mAbs. Existing literature shows that increased renal clearance of monoclonal antibodies in patients with glomerular proteinuria is possible, but it probably depends on the amount of glomerular proteinuria. Based on literature findings and our own, we suggest that in cases of severe glomerular proteinuria, like nephrotic range proteinuria, the likelihood of renal loss of monoclonal antibodies is higher than in other cases.

蛋白尿及其对单克隆抗体排泄的影响:1例派姆单抗病例报告及文献复习。
治疗性单克隆抗体(mab)已经彻底改变了各种疾病的治疗前景,提供了高特异性的靶向治疗选择。在正常生理条件下,它们的大小阻碍肾脏排泄。然而,关于单克隆抗体在大量蛋白尿患者中的药代动力学信息有限,这种情况通常与肾病综合征有关。在这个病例报告中,我们描述了一位患有非小细胞肺癌(NSCLC)和副肿瘤肾病综合征的68岁男性,他每3周接受200毫克派姆单抗治疗。由于肾病综合征患者派姆单抗配置的数据有限,我们监测了派姆单抗的血清和尿液浓度,以确保充分的全身暴露。治疗药物监测结果显示无肾排泄派姆单抗和治疗药物暴露。非小细胞肺癌的治疗导致副肿瘤肾病综合征的改善。我们对不同类型的蛋白尿及其对单克隆抗体排泄的影响进行了文献综述。现有文献显示肾小球蛋白尿患者单克隆抗体的肾脏清除率增高是可能的,但这可能取决于肾小球蛋白尿的量。根据文献和我们自己的研究结果,我们认为在严重肾小球蛋白尿的病例中,如肾病范围蛋白尿,单克隆抗体肾损失的可能性高于其他病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信