Case Report: Fatal Multiorgan Failure and Heterochronous Pneumonitis Following Pembrolizumab Treatment in a Patient With Large-Cell Neuroendocrine Carcinoma of Lung

Xie, Xian-Jin; Wang, Fei; Qin, Yinyin; Lin, Xinhua; Xie, Zhanhong; Liu, Ming; Ouyang, Ming; Luo, Biao; Gu, Yingying; Li, Shiyue; Gu, Dejian; Chen, Rongrong; Zhou, Chengzhi

doi:10.3389/fphar.2020.569466

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…We searched PubMed for relevant articles to validate our findings and selected 30 patients for analysis ( Katsume et al, 2018 ; Khoury et al, 2019 ; Wang and Hu, 2019 ; Balanescu et al, 2020 ; Diamantopoulos et al, 2020 ; Hardy et al, 2020 ; Hyun et al, 2020 ; Leaver et al, 2020 ; Szuchan et al, 2020 ; Tu et al, 2020 ; Valenti-Azcarate et al, 2020 ; Wang et al, 2020 ; Xie et al, 2020 ; Xing et al, 2020 ; Arangalage et al, 2021 ; Cham et al, 2021 ; Chen et al, 2021 ; Elder et al, 2021 ; Iwasaki et al, 2021 ; Komatsu et al, 2021 ; Liang et al, 2021 ; Tanabe et al, 2021 ; Yanase et al, 2021 ; Zhang et al, 2021 ). The results are coincident with ours.…”

Section: Resultsmentioning

confidence: 96%

Intrinsic Differences in Immune Checkpoint Inhibitor-Induced Myocarditis: A Retrospective Analysis of Real World Data

et al. 2022

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Immune-related myocarditis is a severe and even life-threatening immune-related adverse event (irAE) which may also be underestimated due to the challenge in diagnosis. The inherent difference between individuals with immune-associated myocarditis has received little attention. Our study aimed to identify which baseline characteristics could contribute to distinguishing mild from severe ICI myocarditis. A retrospective analysis was conducted between March 2019 and June 2020 in West China Hospital, and 18 patients with immune-related myocarditis were studied. Patients were classified as having mild (n = 12) or severe myocarditis (n = 6), according to the clinical manifestations and hemodynamic complications. Factors associated with severe myocarditis were identified by comparing covariates derived from medical records in various groups. In this retrospective analysis, the median age of the 18 patients was 60 years old. Most myocarditis cases occur early and approximately after the first or second ICI infusion. The severity of myocarditis may be correlated with lactate dehydrogenase (LDH) (p = 0.04) and troponin levels (p = 0.0057). The relationship between troponin and myocarditis was further confirmed in another cohort, which included 30 patients. In addition, patients are more likely to develop multi-irAEs, and myositis was the most common second irAE. Those who experience multi-irAEs usually had significantly higher LDH (p = 0.02) and myoglobin levels (p = 0.02) than those who did not experience them. All patients were treated with steroids timely, and the mortality rate was 5.6% in our study. In this study, we explored risk factors for severe myocarditis and emphasized the importance of a multidisciplinary team in assisting diagnosis and treatment options. It is critical to initiate corticosteroid therapy, regardless of the severity of the myocarditis.

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Section: Resultsmentioning

confidence: 96%

Intrinsic Differences in Immune Checkpoint Inhibitor-Induced Myocarditis: A Retrospective Analysis of Real World Data

et al. 2022

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“…He recovered from the acute phase of MOF, but he subsequently developed a delayed immune-related pneumonia (about 8 weeks after the end of the immunotherapy treatment), responsive to treatment with methylprednisolone. [15] A retrospective study by Salem et al in 2018 reported the association between ICI treatment and the onset of myocarditis: this AE had a median onset time of 30 days from the start of immunotherapy and in 64% of cases it occurred between the first and the second course of treatment. [16] Moreover, a multicentric study by Mahmood et al showed a 1.14% prevalence of myocarditis in patients treated with ICIs.…”

Section: Discussionmentioning

confidence: 99%

Multiorgan failure caused by pembrolizumab and axitinib in a woman affected by metastatic clear cell renal cell carcinoma: A case report and literature review

Di Marco,

Artioli,

Favaretto

et al. 2024

Medicine

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Rationale: Treatment with a combination of immune checkpoint inhibitors (ICIs) (pembrolizumab or nivolumab) and oral Tyrosine Kinase Inhibitors (TKI) targeting angiogenesis (axitinib, cabozantinib or lenvatinib) has shown benefits in terms of efficacy and survival in metastatic renal cell carcinoma (mRCC), with a favorable toxicity profile. However, some rare and serious treatment-related adverse events can be difficult to manage. Patient concerns: Here we report the first case of an mRCC patient who, after only 2 administrations of pembrolizumab-axitinib, experienced severe multiorgan failure (MOF) with heart failure, oliguria and acute hepatitis requiring aggressive supportive treatment in intensive care unit. Diagnoses: A diagnosis of severe MOF induced by pembrolizumab plus axitinib was considered. Interventions: The patient was treated with dobutamine, levosimendan along with high-dose steroids under continuous cardiologic monitoring. Outcomes: After treatment, the patient had a full recovery and was discharged from the hospital. Lessons: We reviewed all the other cases of MOF reported during treatment with combined ICI-TKI in cancer patients in order to summarize incidence, clinical manifestations and management with a specific focus on the need for prompt recognition and aggressive management under multidisciplinary care.

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“…After that, duplicated descriptions of clinical cases that were found in different articles from the same institution were excluded. In the end, 160 articles describing 244 cases were selected [ 16 , 29 , 31 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , …”

Section: Methodsmentioning

confidence: 99%

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

Zotova

2023

Diagnostics

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Myocarditis associated with the use of immune checkpoint inhibitors (ICI) is a rare manifestation of their cardiotoxicity, but is characterized by a high mortality rate. A literature search was conducted using PubMed using keywords, which resulted in the selection of 679 scientific works, from which 160 articles that described 244 clinical cases were selected. The median age of the patients was 67 years (IQR, 60–74). The median time from the start of ICI therapy to the development of the first adverse symptoms was 21 days (IQR, 14–38.3). In 37% of cases, myocarditis developed after the first administration of ICI. Cardiac symptoms were present in 47.1% of cases, neuromuscular symptoms in 30.3%, and other symptoms in 12.6%, while myocarditis was asymptomatic in 10.1% of cases. New changes in the electrocardiograms were detected in 85.1% of patients compared to the initial data. A high incidence of complete atrioventricular block (25.4%), right bundle branch block (18.4%), ventricular tachycardia (13%), and sinus tachycardia (12%) were noted. In 97% of the cases, the patients received prednisolone or methylprednisolone therapy. When using ICI, special attention should be paid to the early detection of possible cardiotoxicity by analyzing the condition and function of the myocardium before treatment and its dynamics.

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Case Report: Fatal Multiorgan Failure and Heterochronous Pneumonitis Following Pembrolizumab Treatment in a Patient With Large-Cell Neuroendocrine Carcinoma of Lung

Cited by 9 publications

References 30 publications

Intrinsic Differences in Immune Checkpoint Inhibitor-Induced Myocarditis: A Retrospective Analysis of Real World Data

Intrinsic Differences in Immune Checkpoint Inhibitor-Induced Myocarditis: A Retrospective Analysis of Real World Data

Multiorgan failure caused by pembrolizumab and axitinib in a woman affected by metastatic clear cell renal cell carcinoma: A case report and literature review

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

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