Pembrolizumab‐induced pancytopenia in a patient with squamous cell lung cancer

Abstract

Immune checkpoint inhibitors (ICIs) are reportedly effective against many kinds of neoplasm, but may be responsible for several kinds of immune‐related adverse events (irAEs). Among these irAEs, the incidence of myelosuppression due to ICIs is relatively low. Corticosteroids are needed to control most cases of myelosuppression. Here, we report an 88‐year‐old woman with squamous cell lung cancer who was administered pembrolizumab. After five cycles of pembrolizumab, she developed severe pancytopenia. The pancytopenia improved under observation without steroid administration after cessation of pembrolizumab. During recovery from this irAE, the patient also maintained long‐term antitumor efficacy. Key points Significant findings of the study There are several kinds of immune‐related adverse events. We encountered a case of pembrolizumab‐induced pancytopenia with squamous cell lung cancer. What this study adds Corticosteroids are needed to control most cases of myelosuppression induced by ICIs, but pancytopenia induced by pembrolizumab in our case improved without steroids.

A modeling-based approach to optimize COVID-19 vaccine dosing schedules for improved protection

“…Of note, in our model we have included a dimensionless coefficient ݂ ‫א‬ [0 ,1] that represents an immunosuppression factor to modulate the carrying capacity (i.e., homeostasis levels) of the naïve immune cell population to model immunocompromised subjects, such that ݂ ൌ 1 in healthy individuals, and ݂ ൏ 1 in immunocompromised patients. Note that since our model is calibrated for patients who are immunocompromised due to anticancer therapy, therefore immunosuppression in our model is characterized by T-and B-cell immunodeficiency, which is one of the important immunological effects observed due to disruption of hematopoiesis leading to myelosuppression in patients undergoing anticancer therapy [53][54][55][56][57]. Also, in the case of naïve CD4+ and CD8+ T-cells we have included the ability of interleukin-6 (IL-6) to cause T-cell exhaustion [58] by including an additional term that limits the carrying capacity of these cells.…”

Exosomal PD-L1: New Insights Into Tumor Immune Escape Mechanisms and Therapeutic Strategies

“…Thus, it should be noted that exploitation of exosome inhibitors for tumor immunotherapy should be conducted with caution due to the potential adverse effects on healthy tissues (Dinkins et al, 2014). In addition, similar to immune checkpoint inhibitors, the restoration of T cell activation mediated by ExoPD-L1 blockade is non-specific and may result in immune-related adverse events (Cuzzubbo et al, 2017;Wanchoo et al, 2017;Barroso-Sousa et al, 2018;Myers, 2018;Sandigursky and Mor, 2018;Sibaud, 2018;Varricchi et al, 2018;Fan et al, 2020;Gauci et al, 2020;Liu T. et al, 2020;Ueki et al, 2020;Williams et al, 2020). Collectively, exosome inhibitors that selectively target cancer cells need to be developed to maximize the antitumor immune responses and minimize the possible side effects of blocking ExoPD-L1 release (Nagai and Muto, 2018;Weinmann and Pisetsky, 2019).…”