Immune-Related Multiple-Organs Injuries Following ICI Treatment With Tislelizumab in an Advanced Non-Small Cell Lung Cancer Patient: A Case Report

Abstract

Immune-related adverse events (irAEs) following treatment with immune checkpoint inhibitors (ICIs) can affect almost any organ systems. Multiple-organs irAEs are a rare occurrence which makes its management and treatment very challenging. This is a case report of a 71-year-old man with advanced non-small cell lung cancer (NSCLC) who developed multiple-organs irAEs (lung, muscle, myocardium, liver, and pituitary) after a single cycle (21 days) of the BGB-A317 (Tislelizumab). After more than two months of immunosuppression treatment with glucocorticoids, the tumor and inflammatory lesions in the lung were reduced. The levels of serum creatase, cardiac troponin T (TNT), and hepatic transaminase were also reduced. Four months after the termination of ICI therapy, the lung tumor reappeared in the previous site. This rare case report supplies several experiences in the management of multiple-organs irAEs, including full-scale monitoring of immunological indicators, early differential diagnosis, and prompt glucocorticoid therapy. This patient was not a candidate for the ICI re-challenge therapy due to the number and seriousness of irAEs. Multiple-organs irAEs add complexity to the management, and additional research is needed to develop optimal therapeutic guidelines.

Immune Checkpoint Inhibitor-Related Myositis Overlapping With Myocarditis: An Institutional Case Series and a Systematic Review of Literature

“…After a review of 1,258 citations in PubMed and the Cochrane Library, 14 case reports, including 14 patients, met the selection criteria of our systematic review ( Saibil et al, 2019 ; Salem et al, 2019 ; Shirai et al, 2019 ; Giancaterino et al, 2020 ; Lie et al, 2020 ; Matsui et al, 2020 ; Todo et al, 2020 ; Xing et al, 2020 ; Cao et al, 2021 ; Deng et al, 2021 ; Hu et al, 2021 ; Jespersen et al, 2021 ; Yang et al, 2021 ; Shindo et al, 2022 ) ( Figure 5 ). The clinical characteristics and prognosis of the 14 patients are summarized in Table 3 .…”

Case Report: Glucocorticoid Effect Observation in a Ureteral Urothelial Cancer Patient With ICI-Associated Myocarditis and Multiple Organ Injuries

“…A summary about irAEs of tislelizumab in clinical trials is shown in Figure 4 ; myocarditis and myositis are not observed. Only one recent case reported multiple organ injuries following tislelizumab treatment in an advanced non-small cell lung cancer patient ( 21 ), while in this case, myocarditis is less severe, and there is not enough reference for us to follow. Our patient presented a rare tislelizumab-related myocarditis, accompanied by myositis and other organ injuries, which also intuitively showed the severity of ICI-associated irAEs to cardiologists like us.…”

Efficacy, prognosis and safety analysis of anti-PD-1/PD-L1 inhibitor rechallenge in advanced lung cancer patients: a cohort study

“…Previous studies have shown that worse clinical outcomes were observed in patients who discontinued ICIs than in continuously treated patients (18)(19)(20)(21). Considering the durable anti-tumor effect of ICI rechallenge reported in several case reports (22)(23)(24), the clinical benefit of restarting ICI has received widespread consideration The efficacy and safety of ICI rechallenge were first explored in melanoma (25). Pollack et al enrolled 80 melanoma patients who discontinued ICIs due to severe irAEs and showed high rates of recurrent or distinct toxicities (12).…”