Aflibercept-induced Nephrotic Syndrome

Abstract

Aflibercept is a high-affinity ligand trap for vascular endothelial growth factor (VEGF) and is used as secondline therapy against metastatic colorectal cancer. It has a similar but potentially less favourable toxicity profile compared with other anti-angiogenic agents. We report a Chinese woman with metastatic colorectal cancer who developed nephrotic syndrome after a single dose of aflibercept (4 mg/kg) with FOLFIRI (leucovorin, fluorouracil, and irinotecan). On days 11 and 18, 24-hour urine collection showed urine protein of 6.07 and 8.72 g/day, respectively. Renal biopsy revealed chronic interstitial nephritis due to underlying obstructive uropathy. The nephrotic syndrome resolved after stopping aflibercept. This illustrates the reversible nature of aflibercept-induced proteinuria, especially when detected and treated early. It is important to monitor the urine protein level in patients prescribed aflibercept, even in those who tolerate other anti-VEGF therapies without significant proteinuria.