Table 1.

Benefits versus risks of drug rechallenge in patients with prior immune checkpoint inhibitor–associated acute kidney injury

Benefits of Rechallenge	Risk of Rechallenge
Data suggest risk of recurrence 7%–20%, on par with or better than AKI recurrence rates for other oncology drugs, including platinum drugs	Recurrence of AKI, including >Grade 3
Risk-minimizing strategies exist: class switching, prophylactic corticosteroids	Side effects of prophylactic corticosteroids
Potential for increased progression-free survival and overall mortality with ongoing use of immunotherapy	With recurrent AKI, options down the line for other therapy (including targeted small molecules and chemotherapy) may be limited
Avoidance of other therapy with greater nephrotoxic potential	Potential need for RRT with severe AKI
Apart from irAEs, better side effect profile of immunotherapy	Healthcare system burden with potential increase in severe AKI requiring RRT
No dose adjustments for patients with CKD (or ESKD)	Recurrent AKI may lead to increased morbidity and mortality
Dosing schedule generally less frequent than chemotherapy, allowing improved QOL for patients	AKI may result in prolonged hospitalization, impeding on patients’ desire to be at home

irAE, immune-related adverse events; QOL, quality of life.