Successful Treatment of Pembrolizumab-Induced Severe Capillary Leak Syndrome and Lymphatic Capillary Dysfunction

Abstract

Although capillary leak syndrome has a high mortality rate, its trigger, diagnosis, and treatment remain a challenge to clinicians because of the poor understanding of its mechanism and lack of treatment guidelines. With the extended use of immune checkpoint inhibitors in modern oncology, immune checkpoint inhibitoreassociated immune-related adverse events have also expanded. We present a case of pembrolizumab-induced capillary leak syndrome and lymphatic capillary dysfunction in which the patient had an excellent clinical response to a tailored treatment strategy.

Anticancer Drug-Induced Capillary Leak Syndrome

“…Case reports suggested the use of anti-VEGF antibody (bevacizumab, 5 mg/kg/d for 5 days) 69 or the anti-VEGF tyrosine kinase inhibitor axitinib in pembrolizumab-induced CLS. 43 Dowden et al. 70 also reported rapid improvement of a patient with classic acute SCLS who got infliximab.…”

“…Ig therapy after a failure of high-dose steroids (3 cases) which have been reported. 41 , 42 , 43 , 44 Therefore, i.v. Ig might be proposed as the initial treatment in the management of immunotherapy-induced CLS.…”

“…Ig might be proposed as the initial treatment in the management of immunotherapy-induced CLS. 41 , 42 , 43 …”

“…Amiloride, which is an epithelial sodium channel blocker with fewer antihypertensive effects, seems the more appropriate diuretic. 43 …”

“…Furthermore, there is evidence of the role of epithelial sodium channel blockers in the activation of antigen-presenting cells leading to T-cell activation and inflammatory cytokines, endothelial function, and vasculature. 43 , 65 Patients who develop oliguric AKI may need kidney replacement therapy. 2 …”