Fatal Airway Inflammation Induced by Pembrolizumab in a Patient With NSCLC

Ogawa, Takunori; Miyata, Jun; Maehara, Junki; Inoue, Takashi; Betsuyaku, Tomoko

doi:10.1016/j.jtho.2018.09.002

Cited by 10 publications

(11 citation statements)

References 5 publications

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“…[ 3 ] On the other hand, Ogawa et al reported pembrolizumab-induced fatal CD8 + infiltrated asthma-like bronchitis in a patient with NSCLC. [ 4 ] Mitropoulou et al reported 2 cases of severe bronchitis attributable to nivolumab with or without ipilimumab in patients with melanoma and NSCLC. [ 5 ] Airway diseases such as asthma and bronchitis have been recognized as a new pattern of irAE; hence, asthma-like symptoms should be monitored when an anti-PD-1 antibody is administered.…”

Section: Discussionmentioning

confidence: 99%

A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer

et al. 2022

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Rationale: Bladder cancer is one of the most common cancers worldwide. The anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab, which is an immune checkpoint inhibitor (ICI), has improved survival in bladder cancer. We report a case of bladder cancer that had a high antitumor effect with anti-programmed cell death PD-1 antibody pembrolizumab, an ICI, but asthma occurred an immune-related adverse event (irAE). Patient concerns: A 70-year-old female patient was diagnosed as unresectable bladder cancer who was indicated for ICI treatment. Diagnosis: After ICI administration as a treatment for bladder cancer, the patient had a grade 3 asthma attack. Cytotoxic T lymphocyte antigen 4 (CTLA-4) in CD4 + FOX3 + T cells was upregulated in the early phase before the development of asthma attacks. Moreover, T-cell immunoglobulin and mucin domain 3 (TIM-3) was upregulated in all memory T cells among CD4 + T cells. However, no change in the expression of TIM-3 was observed in any CD8 + T-cell subtype. In contrast, the proportion of CD161 - T helper 17 cell (Th17) cells increased. Interventions: The patient was treated with betamethasone, montelukast, salbutamol nebulization, and a combination of salmeterol (50 μg) and fluticasone (500 μg) (SFC). Outcomes: The patient's wheezing resolved, and her peak flow rate reached 100% of the predicted value; therefore, the patient continued treatment with SFC and montelukast and was discharged from the hospital. Conclusion: Increases in CTLA-4 and TIM-3 expression in CD4 + T cells (not CD8 + ), as well as an increase in Th17 cells, may reflect asthma-related inflammation activity. Immune-related adverse events during immune checkpoint inhibitor administration may be predictive markers of antitumor efficacy.

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Section: Discussionmentioning

confidence: 99%

A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer

et al. 2022

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“…Main pulmonary toxicities hitherto described are organizing pneumonia, ground‐glass opacities, interstitial lesions, hypersensitivity pneumonitis, or nonspecific interstitial pneumonitis 7 . Some studies have reported that pulmonary toxicities can be fatal, as in the case of acute respiratory distress syndrome (ARDS), 8 or severe acute asthma 5 . Recently, during durvalumab therapy, Yamakasi et al described the appearance of a diffuse micronodular pattern, with predominantly ground‐glass micronodules 9 …”

Section: Discussionmentioning

confidence: 99%

“…Bronchial toxicities induced by anti‐programmed cell death protein‐1 (PD‐1)/PD‐L1 immunotherapy have rarely been reported and rather as an exacerbation of chronic obstructive pulmonary disease (COPD) 5,6 . Here, we report a case of a patient who developed a pattern of bronchiectasis with bronchiolitis during anti‐PD‐L1 treatment with a favorable outcome after discontinuation of immune checkpoint inhibitors (ICIs).…”

Section: Introductionmentioning

confidence: 99%

Durvalumab‐induced lesions of bronchiolitis and fully reversible bronchiectasis in a patient with non‐small cell lung cancer: A case report

et al. 2021

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Durvalumab is a humanized monoclonal antibody targeting programmed cell death ligand‐1 (PD‐L1), leading to an antitumor activity, used as consolidation therapy in patients with locally advanced unresectable non‐small cell lung cancer (NSCLC). Several immune‐related adverse events (irAEs) have previously been described in patients following treatment with immune checkpoint inhibitors (ICIs). To the best of our knowledge, we report the first case of immunotherapy‐induced fully reversible bronchiolitis and bronchiectasis, despite the fact that its pathophysiological mechanism has been previously considered to be irreversible.

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“…There are also case reports of Pembrolizumab-Related Pulmonary Infection Reactivation (TB), Fatal Steroid-Resistant Airway Inflammation (Severe Fatal Asthma Exacerbation), Alveolar Hemorrhage Related to Pembrolizumab, etc [22][23][24].…”

Section: Pulmonary Toxicitymentioning

confidence: 99%

Toxicities of Pembrolizumab in Cancer Patients

Jiang¹,

Lyu²,

Miao³

et al. 2022

HSET

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Pembrolizumab is a humanized anti-PD1 monoclonal antibody that has been approved for immunotherapy of malignant melanoma, classical hodgkin lymphoma, non-small cell lung cancer, etc. However, the toxicity of pembrolizumab has been demonstrated in preclinical and clinical studies. The main side effects of pembrolizumab are related to the activation of various immune cells in the body. The triggered immune system may attack healthy organs, such as the livers, lungs and kidneys. The resulting toxic reactions can cause varying degrees of damage to the patient's body and need to be taken seriously. In response to the toxic side effects of pembrolizumab, discontinuation of the drug is often taken in conjunction with symptomatic treatment, and the herb is a potentially effective drug in many related diseases. In general, the side effects of immune checkpoint inhibitors are relatively minor and serious toxicities are rare, but some of the serious toxicities are fatal. Therefore, early detection and treatment of adverse reactions are of great interest, and mechanisms as well as treatments of toxicity of pembrolizumab requires further studies.

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Fatal Airway Inflammation Induced by Pembrolizumab in a Patient With NSCLC

Cited by 10 publications

References 5 publications

A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer

A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer

Durvalumab‐induced lesions of bronchiolitis and fully reversible bronchiectasis in a patient with non‐small cell lung cancer: A case report

Toxicities of Pembrolizumab in Cancer Patients

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