Severe Thrombocytopenia Associated With Pembrolizumab in Patients With Non-small Cell Lung Cancer (NSCLC): A Case Report and Literature Review

Mouri, Atsuto; Kaira, Kyoichi; Shiono, Ayako; Miura, Yoshihiko; Kagamu, Hiroshi

doi:10.21873/invivo.11852

Cited by 10 publications

(3 citation statements)

References 9 publications

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“…Although ICIs have been approved for treating various types of human malignancies, immune-related thrombocytopenia is most likely to be reported in NSCLC ( 5 – 11 , 24 , 25 ), melanoma ( 12 – 20 ), lymphoma ( 21 ), pancreatic cancer ( 22 ), and renal cell carcinoma ( 23 ), which is consistent with retrospective data from multiple institutions ( 26 ). Previous case and retrospective studies show that immune thrombocytopenia occurred in cancer patients treated with PD-1 inhibitor monotherapy, such as nivolumab or pembrolizumab, or a CTLA-4 inhibitor, or a combination with PD-1 and a CTLA-4 inhibitor ( Table 1 ).…”

Section: Incidence and Onset Of Immune Thrombocytopenia Induced By Icsupporting

confidence: 74%

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

Liu

Liang²,

Liang

et al. 2020

Front. Oncol.

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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.

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Section: Incidence and Onset Of Immune Thrombocytopenia Induced By Icsupporting

confidence: 74%

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

Liu

Liang²,

Liang

et al. 2020

Front. Oncol.

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“…We found 377 studies in the database search. After we deleted duplicates and we analyzed full texts, we included 14 case series and 66 individual case reports4,12–98 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Management and Outcomes of Hematological Immune-related Adverse Events: Systematic Review and Meta-analysis

Wilson¹,

Lockhart

García‐Perdomo

et al. 2021

Journal of Immunotherapy

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Data regarding clinical outcomes and management of hematological manifestations of immune checkpoint inhibition (ICI) is limited to case reports, series, and a few retrospective reviews. We aimed to determine the rate of response of hematological immunerelated adverse events (irAEs) to immunosuppressive therapy. MEDLINE (OVID), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to the present day. Retrospective reports were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. The primary outcome of this study was the rate of response to immunosuppression. Eighty studies (14 case series and 66 individual case reports) were analyzed with a total of 135 patients with ICI-related hematological irAEs. Data analysis showed an average proportional response rate to immunosuppression among hematological irAE entities of 50% (range: 25%-70%). The heterogeneity index (I 2 ) was 0% among reports within each entity. There is a wide spectrum of hematological manifestations to ICI therapy, and to date there is no large randomized-controlled trial data to evaluate the efficacy of treatment strategies for hematological irAEs. We found a variable overall response rate to immunosuppression therapy of around 50%, without statistically significant heterogeneity among different irAE types but significant differences among the different countries of publication. Future studies evaluating the optimal dose and duration of immunosuppressive agents for patients with hematological irAEs should be undertaken.

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“…Most cases were attributed to another ICI (e.g., nivolumab), and very few cases have been associated with pembrolizumab. In a case report by Mouri et al, a patient was found to have grade 4 thrombocytopenia with platelet (Plt) level 0.4 x 10 9 , 21 days following treatment with pembrolizumab and responded well to oral steroids (1 mg/kg/day) [ 16 ]. In another case studied by Song and Zhang, a patient was started on eltrombopag for severe refractory thrombocytopenia caused by pembrolizumab that was not responsive to high dose steroids combined with sufficient immunoglobulin therapy with obvious bleeding symptoms [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple Autoimmune Complications After a Single Dose of Pembrolizumab

Ahdi¹,

AbdulMujeeb²,

Nabrinsky³

2023

Cureus

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Pembrolizumab, a monoclonal antibody that inhibits programmed cell death protein-1 (PD-1), is an important treatment for various malignancies. Unfortunately, it has also been associated with a wide array of immune-related adverse events. We present a unique case of a patient who received a single dose of pembrolizumab and subsequently developed multiple immune-mediated complications, including dermatitis, hepatitis, myositis, myocarditis, and myasthenia gravis.

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Severe Thrombocytopenia Associated With Pembrolizumab in Patients With Non-small Cell Lung Cancer (NSCLC): A Case Report and Literature Review

Cited by 10 publications

References 9 publications

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

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

Management and Outcomes of Hematological Immune-related Adverse Events: Systematic Review and Meta-analysis

Multiple Autoimmune Complications After a Single Dose of Pembrolizumab

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