Immune-related adverse events caused by treatment with pembrolizumab in a patient with lung cancer who infected influenza virus

Abstract

A 67-year-old man with stage IV B lung adenocarcinoma was treated with pembrolizumab. The patient was admitted to the hospital because of influenza on the day of the second cycle of pembrolizumab treatment. He was diagnosed with pneumonia and was treated with antiviral drugs and steroids. However, the patient eventually died. In this case, treatment with immune checkpoint inhibitors might have affected the immune response caused by influenza virus infection, that might have caused lung injury, which is an immune-related adverse event (irAE). Hence, it is important that, caution should be taken to prevent transmission of viral infection, and Therefore, it is important to prevent viral infections, but caution should also be paid to the possibility that infections may cause irAEs in patients with lung cancer.

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

“… 7 , 9 , 10 , 11 In addition, irAEs can be triggered by infections. 12 , 13 In the present case, the patient developed an irAE and showed a favorable response to immunotherapy. The CRS in this case may have been an irAE triggered by infection.…”

“…IrAEs have been suggested to reflect the favorable therapeutic efficacy of ICI treatment, but can sometimes be life‐threatening 7,9–11 . In addition, irAEs can be triggered by infections 12,13 . In the present case, the patient developed an irAE and showed a favorable response to immunotherapy.…”

Retrospective analysis of clinical trial safety data for pembrolizumab reveals the effect of co-occurring infections on immune-related adverse events

“…There are a few cases and smaller scale studies discussing the irAE/infection association [31,32], and some attributing the related organ damage to irAE exacerbation due to a concurrent infection [33]. Although intuitively it makes sense that an infection can affect the irAE, this association had not been quantified in large studies.…”

Influenza Vaccination in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

“…Surprisingly, a trend toward fewer irAEs was observed in vaccinated patients. It should be emphasized that influenza virus per se has been proposed to play a role in the induction of irAEs 52. In this context, it appears even more reasonable to consider influenza vaccination safe and potentially beneficial for this subgroup of patients 52…”

“…It should be emphasized that influenza virus per se has been proposed to play a role in the induction of irAEs. 52 In this context, it appears even more reasonable to consider influenza vaccination safe and potentially beneficial for this subgroup of patients. 52 Regarding the effect of influenza vaccination on cancerrelated outcomes it could be hypothesized that by preventing a potentially lethal infection, overall survival of these frail patients could be prolonged.…”