Cavitation and fatal hemoptysis after immunotherapy for advanced lung adenocarcinoma: A case report

Abstract

Immune checkpoint inhibitor (ICI)‐related massive hemoptysis with cavitation has rarely been identified. Here, we report a case of advanced lung adenocarcinoma with lethal bleeding after eight cycles of pembrolizumab. A 55‐year‐old male was diagnosed with stage IV non‐small cell lung cancer (NSCLC). Following confirmation of high programmed death‐ligand 1 (PD‐L1) expression of 60% cancer cells, he subsequently received pembrolizumab monotherapy. His symptoms and chest images significantly improved after four cycles of therapy. However, after eight cycles of immunotherapy, he presented with recurrence of bloody sputum and shortness of breath. Pembrolizumab was discontinued and a diagnosis of checkpoint inhibitor‐associated pneumonitis (CIP) was made. When the CIP was absorbed after glucocorticoid therapy, the patient died of sudden massive hemoptysis with cavitation in the lesion. Key points Although checkpoint inhibitor associated pneumonitis was the leading cause of ICI‐related death, clinicians should be alerted to the finding that more attention should be given to hemoptysis attributed to ICI therapy in advanced lung cancer.

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

“…The lengths of steroid courses from our data varied from 1 week to 73.4 weeks, and the mean duration for grade ≥ 2 CIP was more than 10 weeks (Tables 2 and 3). However, in patients whose steroid course was shorter than 5 weeks (25,49,55,59,67,72,75,82), two patients (25, 67) experienced CIP recurrence. The highest CIP recurrence rate, 22.22%, occurred in patients with grade 2 CIP (Table 3).…”

Pembrolizumab plus lenvatinib in advanced endometrial cancer: case report and systematic review of lung toxicity

“…Pneumonitis is the only pulmonary disease of immune checkpoint inhibitors (frequency <5%). Moreover, an interesting report on unusual pulmonary toxicity was described in Beijing, where a patient suffering from non-small cell lung cancer (NSCLC) and treated with pembrolizumab presented an atypical lung toxicity with hemoptysis and cavitation, in the absence of other possible causes ( 44 ).…”

“…According to our selection, Table 1 describes literature reports on lung toxicity (40)(41)(42)(43)(44)(45). Several data described similar experience in terms of pulmonary toxicity related to the use of these drugs in different types of tumors.…”