Multi‐organs perioperative immune‐related adverse events and postoperative bronchial anastomotic fistula in a patient receiving neoadjuvant immunotherapy with NSCLC

Abstract

The safety of neoadjuvant chemoimmunotherapy before surgery in patients with non–small cell lung cancer (NSCLC) remains unclear in the perioperative stage. We describe a case of a 63‐year‐old man with IIIC stage NSCLC who received neoadjuvant chemoimmunotherapy and radical lobectomy. After the second cycle of pembrolizumab and chemotherapy (paclitaxel + carboplatin), the patient was diagnosed with immunologic enterocolitis and relieved by glucocorticoid therapy. Radical lobectomy of the right upper lobe was then performed. On postoperative day 4 (POD 4), the patient suddenly suffered suffocated wheezing during sleep. Interstitial lung disease was, therefore, identified by chest computed tomography scan. Glucocorticoids and mechanical ventilation were applied and the symptoms were relieved. On POD 10, the patient developed a bronchial fistula and underwent emergent repair surgery. This is the first case of multi‐organs, multi‐time point immune‐related adverse events (irAE) in perioperative NSCLC patients who received neoadjuvant chemoimmunotherapy. Clinicians should be on high alert for signs of irAEs in neoadjuvant chemoimmunotherapy patients, promptly requiring multidisciplinary management.

Is response evaluation criteria in solid tumors (RECIST) effective in patient selection for radical resection after neoadjuvant immunotherapy with advanced NSCLC?

“…Ten patients (16.9%) had immune‐related adverse events (irAEs), including rash ( n = 6), immune‐related thyroiditis ( n = 2), immune‐related enteritis ( n = 1) and immune‐related pneumonia ( n = 2). Only one grade 3–4 adverse reaction was observed (see our previous case report) 7 . Two patients’ surgeries were delayed because of irAEs.…”

“…Only one grade 3–4 adverse reaction was observed (see our previous case report). 7 Two patients’ surgeries were delayed because of irAEs.…”

Remitting Seronegative Symmetrical Synovitis with Pitting Edema: A Case Report of an Immune-Related Adverse Event following Surgery

“…Concordant with this hypothesis, Zhao et al [18] have published a report of a patient with locally advanced non-small cell lung cancer receiving nivolumab who developed pneumonitis requiring ICU admission 1 week after bilobectomy. Two other similar, albeit milder, cases of ICI-related interstitial lung disease after thoracic surgery for non-small cell lung cancer have been reported [19,20]. Likewise, Sasaki et al [21] have reported a case of ICI-related hypopituitarism and hypothyroidism 4 days after partial hepatectomy for liver metastases in a patient with gastric cancer treated with Fig.…”

Perioperative immunotherapy for stage II-III non-small cell lung cancer: a meta-analysis base on randomized controlled trials

“…In clinical practice, although the incidence of AEs in immunotherapy is often much lower than that in chemotherapy, immune related AEs (such as pneumonitis, myocarditis, etc.) are often challenging to manage and can substantially impact the quality of life ( 35 ). At different periods of this study, it was observed that the incidence of total AEs, grade 3-5 AEs, serious AEs, and fatal AEs was higher in the PIO group than in the PP group in varying degrees, especially during the neoadjuvant treatment phase.…”