Fatal adverse events in two thymoma patients treated with anti-PD-1 immune check point inhibitor and literature review

Thomopoulou, Konstantina; Rounis, Konstantinos; Anastasios, Koutsopoulos; Mala, Anastasia; Eleni, Lagoudaki; Sougklakos, Ioannis; Asioli, Sofia; Mavroudis, Dimitris

doi:10.1016/j.lungcan.2019.06.015

Cited by 53 publications

(46 citation statements)

References 12 publications

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“…It is important to distinguish between thymic carcinoma and thymomas while selecting active drugs for treatment 10 . Fatal toxicities have been reported in patients with thymoma who were treated with pembrolizumab 15,28 …”

Section: Discussionmentioning

confidence: 99%

“…It is important to distinguish between thymic carcinoma and thymomas while selecting active drugs for treatment. 10 Fatal toxicities have been reported in patients with thymoma who were treated with pembrolizumab 15,28 Further studies investigating new drugs or combinations of active drugs are essential. Also, additional biological studies on drug development for rare cancers are important.…”

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confidence: 99%

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Phase II trial of S‐1 treatment as palliative‐intent chemotherapy for previously treated advanced thymic carcinoma

Okuma

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Ohyanagi

et al. 2020

Cancer Medicine

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Phase II trial of S‐1 treatment as palliative‐intent chemotherapy for previously treated advanced thymic carcinoma

Okuma

Goto²,

Ohyanagi

et al. 2020

Cancer Medicine

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“…Literature data include sporadic additional case reports describing thymoma patients treated with ICIs and fatal multiorgan failure including myocarditis and myasthenia gravis, highlighting a critical scenario in terms of efficacy and toxicity (14,15). Indeed, the anti-tumoral effect of ICIs often mirrors the onset of severe irAEs due to still-unexplored reasons.…”

Section: Discussionmentioning

confidence: 99%

“…evident anti-tumor activity, immune-checkpoint inhibitors (ICIs) have displayed a critical immune-mediated toxicity profile; therefore, their safety represents an evolving landscape (10,12,13). Specifically, severe systemic ICI-related side effects in patients with thymoma have been described, including myocarditis, hepatitis, and myositis, highlighting the importance of careful patient selection while evaluating immunotherapeutic agents for treatment ( Supplementary Table 1) (10,12,14,15).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Lymphocytosis Associated With Fatal Hepatitis in a Thymoma Patient Treated With Anti-PD1: New Insight Into the Immune-Related Storm

et al. 2020

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Recent advances in tumor immunotherapy have made it possible to efficiently unleash immune effectors, reacting against neoplastic cells. Although these approaches primarily aim to eradicate malignancy, immune-related adverse events (irAEs) often influence patients’ prognosis, constituting a new spectrum of side effects. Taking into account the typical microenvironment and the intricate equilibrium between the anti-tumor response and the immune cells, the thymoma constitutes a unicum in the immune-oncology field. We report a fatal immune-mediated adverse events’ storm in a thymoma patient treated with Pembrolizumab, leading to hepatotoxicity accompanied by lymphocytosis, thrombocytopenia, and thyroid dysfunction, unveiling a novel potential pathophysiological effect of immunotherapy. The clinical proficiency of the immune checkpoint inhibitors in thymoma patients warrants timely prevention and management of off-target consequences in order to optimize this promising therapeutic option. This case report describes a unique consequence of irAEs, emerging as a red flag warranting a multidisciplinary approach.

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“…Recently, treatment with ICP inhibitors has been proposed for advanced thymoma and thymic carcinoma and is currently being evaluated in phase 2 trials. However, all these diseases as severe or fatal irAEs were reported during anti-PD1 treatment in these cases [70,71]. MG onset or deterioration generally occurred in the early phase of ICI treatment.…”

Section: Mg Complicating Treatment With Immune Checkpoint Inhibitorsmentioning

confidence: 91%

Benefit and danger from immunotherapy in myasthenia gravis

et al. 2021

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In the last years, significant advances have improved the knowledge of myasthenia gravis (MG) immunopathogenesis and have enabled to realize new molecules with a selective action targeting compounds of the immunological system. This review discusses emerging treatments for MG, including complement inhibitors, neonatal Fc receptor targeting agents, and B cell interfering drugs, focusing on benefit and danger. In the second section of the review, several related adverse events of immunotherapy, including MGonset, are debated.

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Fatal adverse events in two thymoma patients treated with anti-PD-1 immune check point inhibitor and literature review

Cited by 53 publications

References 12 publications

Phase II trial of S‐1 treatment as palliative‐intent chemotherapy for previously treated advanced thymic carcinoma

Phase II trial of S‐1 treatment as palliative‐intent chemotherapy for previously treated advanced thymic carcinoma

Case Report: Lymphocytosis Associated With Fatal Hepatitis in a Thymoma Patient Treated With Anti-PD1: New Insight Into the Immune-Related Storm

Benefit and danger from immunotherapy in myasthenia gravis

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