PT - JOURNAL ARTICLE AU - Jamie S Lin AU - Daniel Y Wang AU - Omar Mamlouk AU - William F Glass AU - Maen Abdelrahim AU - Cassian Yee AU - Ala Abudayyeh TI - Immune checkpoint inhibitor associated reactivation of primary membranous nephropathy responsive to rituximab AID - 10.1136/jitc-2020-001287 DP - 2020 Oct 01 TA - Journal for ImmunoTherapy of Cancer PG - e001287 VI - 8 IP - 2 4099 - http://jitc.bmj.com/content/8/2/e001287.short 4100 - http://jitc.bmj.com/content/8/2/e001287.full SO - J Immunother Cancer2020 Oct 01; 8 AB - The same mechanisms that mediate antitumor immunity from checkpoint inhibitors (CPIs) can also lead to unintended targeting of normal tissues, characterized as immune-related adverse events (irAEs). Those with pre-existing autoimmune disease are believed to be particularly vulnerable for exacerbating underlying autoimmunity or inducing severe irAEs. We report the first case of CPI-associated reactivation of primary membranous nephropathy (MN) in a patient with pleural mesothelioma responding to immunotherapy. Due to its specificity in targeting B-lymphocytes, rituximab was used to treat primary MN with the expectation that this would not interfere with the benefits gained from T cell-mediated antitumor immunity. Rituximab was effective in treating CPI-associated reactivation of MN, and the patient was successfully rechallenged with nivolumab and maintained stable kidney function and sustained clinical antitumor effect. While exacerbation of pre-existing autoimmune diseases from CPIs is common, therapy for autoimmune reactivation can be rationally directed by an understanding of the immunosuppressive mechanism with goals of cancer treatment.