Pembrolizumab combined with stereotactic body radiotherapy in a patient with human immunodeficiency virus and advanced non-small cell lung cancer: a case report

Abstract

BackgroundPembrolizumab has significantly improved outcomes in patients with advanced non-small cell lung cancer. Combining programmed death-1 inhibitor with stereotactic body radiotherapy showed a slight toxicity and good benefits in recent clinical trials. However, patients infected with human immunodeficiency virus were excluded from most trials because it was assumed that their anti-tumor immunity was compromised compared with immunocompetent patients.Case presentationIn June 2016, a 52-year-old Chinese man presented with human immunodeficiency virus and lung adenocarcinoma (T1bN3M1b). From November 2016 to December 2016, systemic chemotherapy and palliative radiotherapy for bone metastasis of femoral neck were carried out, but the tumor progressed. In January 2017, after immunochemistry detection of programmed death-1 and programmed death-ligand 1 expression (both > 50%), pembrolizumab was started. Three weeks after pembrolizumab, we combined stereotactic body radiotherapy for the primary lung tumor. He received no comfort and his CD4 lymphocyte count was stable. Human immunodeficiency virus-ribonucleic acid remained below the limits of detection. In March 2017, after three cycles of pembrolizumab and 5 weeks of stereotactic body radiotherapy therapy, he suddenly presented with palpitations. Emergency computed tomography scanning showed massive pericardial effusion and interstitial pneumonia. So we interrupted the pembrolizumab use and initiated treatment with prednisolone 1 mg/kg; however, the tumor progressed. Then, his CD4 lymphocyte count declined. Finally he died in June 2017 due to dyscrasia.ConclusionsPembrolizumab combined with SBRT therapy for patients with human immunodeficiency virus infection and non-small cell lung cancer may lead to serious immune-related adverse events and more clinical trials are needed.

Why should radiological oncology do translational research?

“…31 Some of the used agents are Ipilimumab. [32][33][34][35] Nanomedicine is the use of nanotechnology in medical science. It refers to the manipulation of size and shape of a material at the nano-level (1-100 nm).…”

Management of immune checkpoint inhibitor‐related adverse events: A review of case reports

“…Li et al . reported that a patient with HIV infection and non‐small cell lung cancer was treated with pembrolizumab and SBRT, and then experienced massive pericardial effusion and interstitial pneumonia . However, this case failed to explain the relationship between HIV infection and AEs.…”

“…Most patients required discontinuation of therapy completely for a short period of time as well as immunosuppressant treatment. (32) Vitiligo (1), granuloma annulare (2), bullous pemphigoid (3), psoriasis (22), erythema multiforme (1), lichenoid reaction (2), Grover's disease (1) Endocrinologic (52) Type 1 diabetes mellitus (38), hypophysitis (9), isolated adrenal insufficiency (1), thyroid storm (2), hypothyroidism (2) Gastrointestinal (47) Acute liver failure (1), hepatitis (8), bile duct obstruction (1), cholangitis (1), pancreatitis (1), hemorrhagic gastritis (1), ileitis (1), colitis (32), intestinal obstruction (1) Pulmonary (11) Organizing pneumonia (5), sarcoidosis (2), pneumonitis (4) Neurologic (20) Myasthenia gravis (5), Guillain-Barre syndrome (3), cerebral edema (1), necrotizing encephalopathy (1), encephalitis (2), mononeuropathy multiplex with rhabdomyolysis (1), necrotic myelopathy (1), Bell's palsy (1), inflammation enteric neuropathy (1), brachial plexus neuritis (2), peripheral neuropathy (2) Cardiac (7) Myocarditis (2), cardiomyopathy (1), coronary spasm (1), pericardial effusion (3) Rheumatologic (28) Remitting seronegative symmetrical synovitis with pitting edema (1), arthritis (12), dermatomyositis/myositis (4), Goodpasture's disease (1), scleroderma (2), polymyalgia rheumatic (3), sicca syndrome (5) Nephrotic (7) Cystitis (1), renal failure (1), nephrotic syndrome (4), acute glomerulonephritis (1) Hematologic (16) Pancytopenia (2), neutropenia (6), aplastic anemia (2), pure red cell aplasia (1), thrombocytopenia (3), acute thrombosis (1), hemophagocytic lymphohistiocytosis (1) Ophthalmologic (17) Uveitis (7), Vogt-Koyanagi-Harada disease-like uveitis (2), orbital inflammation (3), dry eye (2), ulcerative keratitis (1), ocular myositis (2) Otorhinolaryngologic (2) Sinusitis…”

Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

“…It is not clear whether the stereotactic body radiotherapy and pembrolizumab interaction was the cause of these events. 65 Surgery is a primary part of treatment for solid tumor malignancies such as lung, anal, prostate, liver, and breast cancers. In the modern ART era, some experts believe that the overall health or performance status is a more reliable indicator of successful surgical outcomes than CD4 count or viral load in PLWH, and that HIV status should not affect choices about surgery.…”

“…64 However, data are more limited in other cancers and in combination with immunotherapies. 10,65 A 52-year-old man with NSCLC experienced pericardial effusion and interstitial pneumonia after 5 weeks of stereotactic body radiotherapy and 3 cycles of pembrolizumab. After the interruption of pembrolizumab, tumor growth progressed.…”