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Multiple and Secondary Primary Cancers · Journal article
Expert Review of Anticancer Therapy · August 15, 2026
Raises a question worth testing. It does not answer one.
This is a narrative review proposing that secondary AA amyloidosis may occur as a rare renal immune-related adverse event in patients receiving immune checkpoint inhibitors, driven by sustained systemic inflammation rather than direct kidney immune injury. The source synthesizes case reports and pharmacovigilance signals to outline mechanisms and clinical features, but explicitly states that causality remains unestablished, mechanisms are hypothetical, and evidence is scarce; recommendations are grounded in expert opinion pending validation.
Narrative review integrating case reports and pharmacovigilance analysis. ICI-treated patients with renal toxicity attributed to or suspected of being secondary AA amyloidosis; case reports and pharmacovigilance signals. Intervention: Immune checkpoint inhibitor therapy (PD-1/PD-L1 blockade).
11 case reports and 26 pharmacovigilance reports of ICI-associated AA amyloidosis identified in literature and FAERS analysis Proposed mechanism links PD-1/PD-L1 blockade to cytokine activation, hepatic amyloid A production, and renal deposition, presented as hypothesis rather than confirmed pathway Limited reversibility of nephrotic syndrome once established; creatinine-based monitoring insufficient for detection; renal biopsy emphasized as diagnostically important
11 case reports and 26 pharmacovigilance reports of ICI-associated AA amyloidosis identified in literature and FAERS analysis
Clinicians should maintain heightened awareness of AA amyloidosis as a rare but severe ICI-related renal toxicity and lower the threshold for nephrology referral and renal biopsy in ICI-treated patients with unexplained proteinuria. Evidence remains insufficient to guide management beyond empirical approaches and early detection strategies.
A narrative review synthesizing case reports and pharmacovigilance signals to propose mechanisms linking ICI use to AA amyloidosis; the source explicitly states mechanisms are hypotheses rather than confirmed pathways and evidence remains scarce with causality unestablished.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should maintain heightened awareness of AA amyloidosis as a rare but severe ICI-related renal toxicity and lower the threshold for nephrology referral and renal biopsy in ICI-treated patients with unexplained proteinuria. Evidence remains insufficient to guide management beyond empirical approaches and early detection strategies.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
INTRODUCTION: Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but produced immune-related adverse events across multiple organs. Renal toxicities are uncommon yet significant, and secondary serum amyloid A (AA) amyloidosis has emerged as a rare, underrecognized complication reflecting sustained systemic inflammation rather than direct immune-mediated kidney injury. AREAS COVERED: This review summarizes evidence on AA amyloidosis as a renal adverse event of checkpoint inhibition, drawing on case reports, a systematic pharmacovigilance (FAERS) analysis, and mechanistic extrapolation from AA amyloidosis biology and cytokine signaling. Proposed mechanisms linking PD-1/PD-L1 blockade to cytokine activation, hepatic amyloid A production, and deposition are discussed as hypotheses rather than confirmed pathways. Clinical features, diagnostic challenges, and outcomes are characterized, emphasizing limits of creatinine-based monitoring, biopsy's importance, and limited reversibility once nephrotic syndrome develops. EXPERT OPINION: ICI-associated AA amyloidosis is a severe, inflammation-driven toxicity likely underdiagnosed. Management remains empirical, grounded in mechanistic rationale and case experience rather than trials, often ineffective once nephrotic syndrome is established. Greater awareness, early nephrology referral, and a low threshold for biopsy should become routine for ICI-treated patients with unexplained proteinuria. Evidence remains scarce (11 cases, 26 pharmacovigilance reports), so recommendations reflect expert opinion pending validation; causality with amyloidogenesis remains unestablished.
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