Cytokine Release Syndrome and Immune-Related Pneumonitis Associated With Tumor Progression in a Pulmonary Pleomorphic Carcinoma Treated With Nivolumab Plus Ipilimumab Treatment: A Case Report

Abstract

Effective control of severe immune-related adverse events, including cytokine release syndrome (CRS), is essential for the success of immunotherapy. We present a case of a granulocyte colony-stimulating factor–producing pleomorphic lung carcinoma treated with nivolumab plus ipilimumab which developed CRS and severe immune-related pneumonitis. The effect of immunotherapy was heterogeneous; gastric metastasis was eliminated, but the pulmonary lesion had primary resistance. Steroid and tocilizumab were successful in controlling CRS, but additional infliximab was necessary to control pneumonitis. To control immune-related adverse events, it is important to choose immunosuppressive agents to the specific target organ and inflammatory cells.

A case of cytokine release syndrome accompanied with COVID‐19 infection during treatment with immune checkpoint inhibitors for non‐small cell lung cancer

“…Because of the progressively increasing use of ICIs, CRS induced by ICIs is becoming more easily recognized and diagnosed. 8 , 14 , 15 , 16 …”

“…Several ICIs are linked to CRS, including anti‐programmed cell death protein‐1/ligand‐1 antibodies, and anticytotoxic T lymphocyte antigen‐4 antibodies. Because of the progressively increasing use of ICIs, CRS induced by ICIs is becoming more easily recognized and diagnosed 8,14–16 …”

“…Because of the progressively increasing use of ICIs, CRS induced by ICIs is becoming more easily recognized and diagnosed. 8,[14][15][16] Previously reported CRS cases induced by nivolumab plus ipilimumab are summarized in Table 2. IL-6 values varied from case to case, but the patient described herein had the highest value.…”

Severe cytokine release syndrome induced by immune checkpoint inhibitors in cancer patients – A case report and review of the literature

“…Subsequently, an additional seven papers were excluded upon closer inspection, as they pertained to hemophagocytic lymphohistiocytosis, capillary-leak syndrome, or anti-CD19 chimeric antigen receptor (CAR) T-cell therapy. In total, we accurately summarized 22 papers [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. A total of 49 patients were enrolled.…”