Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient

Abstract

Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient Dear Editor, A 45-year-old man, who was referred to our clinic for an expanding melanotic macule on his abdomen, was diagnosed with malignant melanoma (T3aN0M0, stage IIA) based on a skin biopsy. Surgical removal of his tumor was performed. Five years after his first surgical procedure, inguinal and external iliac lymph node metastases were discovered and lymph node dissection was performed. Many tumor-infiltrating lymphocytes (TIL) were found in the metastatic lesions. The TIL profile consisted of cells that were positive for CD8, programmed death 1

Immune Checkpoint Inhibitor–Associated Tumor Lysis Syndrome: A Real-World Pharmacovigilance Study

“…However, some metabolic disorders in the context of TLS including hyperkalemia and acute kidney injury were occasionally reported in association with pembrolizumab ( Langer et al, 2016 ; Goldberg et al, 2020 ; Middleton et al, 2020 ), avelumab ( Barlesi et al, 2018 ), and durvalumab uses ( Massard et al, 2016 ). Currently, just eight case reports of individuals developing TLS while receiving treatment with ICIs or co-chemotherapy have been reported in the PubMed database ( Masson Regnault et al, 2017 ; Fa’ak et al, 2019 ; Carrier et al, 2020 ; Magara et al, 2020 ; Narukawa et al, 2020 ; Shah et al, 2020 ; Sugimoto et al, 2020 ; Yen et al, 2020 ). All cases involved solid tumors—three cases of metastatic melanoma ( Masson Regnault et al, 2017 ; Magara et al, 2020 ; Sugimoto et al, 2020 ), three cases of genitourinary malignancies ( Fa’ak et al, 2019 ; Narukawa et al, 2020 ; Shah et al, 2020 ), one case of hepatocellular carcinoma ( Yen et al, 2020 ), and one case of metastatic triple-negative breast cancer ( Carrier et al, 2020 ).…”

“…Currently, just eight case reports of individuals developing TLS while receiving treatment with ICIs or co-chemotherapy have been reported in the PubMed database ( Masson Regnault et al, 2017 ; Fa’ak et al, 2019 ; Carrier et al, 2020 ; Magara et al, 2020 ; Narukawa et al, 2020 ; Shah et al, 2020 ; Sugimoto et al, 2020 ; Yen et al, 2020 ). All cases involved solid tumors—three cases of metastatic melanoma ( Masson Regnault et al, 2017 ; Magara et al, 2020 ; Sugimoto et al, 2020 ), three cases of genitourinary malignancies ( Fa’ak et al, 2019 ; Narukawa et al, 2020 ; Shah et al, 2020 ), one case of hepatocellular carcinoma ( Yen et al, 2020 ), and one case of metastatic triple-negative breast cancer ( Carrier et al, 2020 ). These patients were treated with atezolizumab, nivolumab, or ipilimumab monotherapy ( Masson Regnault et al, 2017 ; Fa’ak et al, 2019 ; Sugimoto et al, 2020 ); combined therapy of nivolumab plus ipilimumab ( Magara et al, 2020 ); co-chemotherapy with nanoparticle albumin-bound-paclitaxel and atezolizumab ( Carrier et al, 2020 ); nivolumab plus sorafenib ( Yen et al, 2020 ); pazopanib after nivolumab ( Narukawa et al, 2020 ); or pembrolizumab plus axitinib ( Shah et al, 2020 ).…”

“…Currently, just eight case reports of individuals developing TLS while receiving treatment with ICIs or co-chemotherapy have been reported in the PubMed database (Masson Regnault et al, 2017;Fa'ak et al, 2019;Carrier et al, 2020;Magara et al, 2020;Narukawa et al, 2020;Shah et al, 2020;Sugimoto et al, 2020;Yen et al, 2020). All cases involved solid tumors-three cases of metastatic melanoma (Masson Regnault et al, 2017;Magara et al, 2020;Sugimoto et al, 2020), three cases of genitourinary malignancies (Fa'ak et al, 2019;Narukawa et al, 2020;Shah et al, 2020), one case of hepatocellular carcinoma (Yen et al, 2020), and one case of metastatic triple-negative breast cancer (Carrier et al, 2020). CTLA-4, cytotoxic T lymphocyte antigen-4; PD-1, programmed death receptor-1; PD-L1, programmed cell death 1 ligand 1; N, number of cases; ROR, reporting odds ratio; CI, confidence interval; PRR, proportional reporting ratio; χ2, chi-squared; IC, information component; IC025, the lower limit of the 95% two-sided CI of the IC; EBGM, empirical Bayesian geometric mean; EB05, the lower 90% one-sided CI of EBGM.…”

“…These patients were treated with atezolizumab, nivolumab, or ipilimumab monotherapy (Masson Regnault et al, 2017;Fa'ak et al, 2019;Sugimoto et al, 2020); combined therapy of nivolumab plus ipilimumab (Magara et al, 2020); cochemotherapy with nanoparticle albumin-bound-paclitaxel and atezolizumab (Carrier et al, 2020); nivolumab plus sorafenib (Yen et al, 2020); pazopanib after nivolumab (Narukawa et al, 2020); or pembrolizumab plus axitinib (Shah et al, 2020). The age range of the patients was 37-79 years, with a mean age of 58.5 years.…”

Association of Tumor Lysis Syndrome and Metastatic Melanoma

“…Although TLS is a wellcharacterized complication for hematologic malignancies such as acute lymphoblastic leukemia, it is underreported in solid tumors [2]. Between 1994 and 2020, we identified 18 different cases of TLS associated with malignant melanoma [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The objective of this study was to examine published information on management, characteristics, and outcomes of patients with TLS associated with malignant melanoma.…”