Immune Thrombocytopenia Induced by Immune Checkpoint Inhibitors in Solid Cancer: Case Report and Literature Review

Abstract

Immune checkpoint inhibitors, including antibodies targeting programmed cell death protein-1 (PD-1) and its receptor programmed cell death ligand-1 (PD-L1), represent promising therapeutic strategies for advanced human malignancies. However, a subgroup of patients experiences various autoimmune toxicities, termed immune-related adverse events (irAEs), that occur as a result of on-target and off-tumor autoimmune responses. Although irAEs are generally confirmed to be less severe than toxicities caused by conventional chemotherapy and targeted therapy, uncommon irAEs, such as immune thrombocytopenia, may occur with a very low incidence and sometimes be severe or fatal. This review focuses on the epidemiology, clinical presentation, and prognosis of immune thrombocytopenia occurring in advanced cancer patients induced by immune checkpoint inhibitors, especially in those with PD-1 or PD-L1 inhibitor treatment. We also first present one patient with non-small cell lung cancer who received the PD-L1 inhibitor durvalumab and developed severe thrombocytopenia.

Immune‐mediated thrombocytopenia induced with durvalumab after chemoradiotherapy in a non‐small cell lung cancer patient: A case report

“…Although ICIs are considered to be more tolerable than cytotoxic agent regarding hematological toxicities, thrombocytopenia can rarely be fatal. Up to today, there have been only approximately 10 reports 4 . The diagnosis of immune‐mediated thrombocytopenia requires exclusion of other causes, such as dysplasia, cancer invasion, or coagulopathy.…”

“…Up to today, there have been only approximately 10 reports. 4 The diagnosis of immune‐mediated thrombocytopenia requires exclusion of other causes, such as dysplasia, cancer invasion, or coagulopathy. The patient's hyperfibrinolysis did not seem to affect thrombocytopenia because it did not change even after treatment.…”

Drawbacks of Immune Checkpoint Inhibition and Rigorous Management for Immune Related Adverse Events Along with a Strategy Against Tumor Plasticity

“…One has to be very careful by presenting the onset frequency of irAEs, as the numbers vary widely in the literature each based on different study models with their own limitations [15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Perspectives of vitamin C upregulating regulatory T cells in the era of thrombopoietin receptor agonists for immune thrombocytopenia

“…Incidentally, the clinical experience in this era of cancer immunotherapy also tallied with published reports of a rare occurrence of secondary ITPs. 4,5 Although this article is on adult ITP, it should be noted that genetic defects may even manifest in older age groups. Fortunately, recent immunological testing helps considerably except the complexity of testing and the interpretation of results would usually demand adequate communications with laboratory immunologists.…”