A Case Report of Severe Type B Lactic Acidosis Following First Dose of Nivolumab in a VHL-Mutated Metastatic Renal Cell Carcinoma.

Kidney cancer (Clifton, Va.) Pub Date : 2017-07-26 DOI:10.3233/KCA-160004

Erica Nakajima, Paul Leger, Ingrid A Mayer, Michael N Neuss, David D Chism, W Kimryn Rathmell

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引用次数: 2

Abstract

We report a case of severe type B lactic acidosis (LA) in a 51-year-old male, 12 days after he received his first dose of nivolumab for metastatic Von Hippel Lindau (VHL)-mutated, clear cell renal cell carcinoma. Throughout his hospital course, infection, hypoperfusion, and tissue necrosis were not identified. We propose that his LA may have resulted from either inherent tumor glycolysis or immune activation and enhanced metabolism. The patient's course was complicated by acute renal failure, and his LA rose progressively, eventually necessitating daily hemodialysis (HD). After receiving five consecutive days of HD, the patient started everolimus daily with the intent of reducing glycolytic metabolism. Subsequently, the rate of lactic acid production slowed, and HD was no longer required after two doses of everolimus. To our knowledge, this is the first reported case of type B LA following nivolumab administration, and the use of everolimus to treat type B LA in a patient with renal cancer.

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1例vhl突变的转移性肾细胞癌患者首次服用纳武单抗后发生严重B型乳酸酸中毒

我们报告一例严重的B型乳酸酸中毒(LA)的51岁男性，12天后，他接受了他的第一剂纳沃单抗转移性Von Hippel - Lindau (VHL)突变，透明细胞肾细胞癌。在整个住院过程中，未发现感染、灌注不足和组织坏死。我们认为他的LA可能是由固有的肿瘤糖酵解或免疫激活和代谢增强引起的。患者的病程因急性肾功能衰竭而复杂化，他的LA逐渐升高，最终需要每日血液透析(HD)。在连续5天接受HD治疗后，患者开始每天服用依维莫司，目的是降低糖酵解代谢。随后，乳酸生成速率减慢，两剂依维莫司后不再需要HD。据我们所知，这是第一例在纳武单抗治疗和依维莫司治疗肾癌患者后出现B型LA的报道。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Kidney cancer (Clifton, Va.)

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