Multiple autoimmune side effects of immune checkpoint inhibitors in a patient with metastatic melanoma receiving pembrolizumab
| Autor: | Nikhila Kethireddy, Prateek Shukla, Steffi Thomas, Poorva Bindal, Upendra P. Hegde |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Aged
80 and over Male 0301 basic medicine Metastatic melanoma business.industry Immune checkpoint inhibitors Melanoma Pembrolizumab Antibodies Monoclonal Humanized medicine.disease B7-H1 Antigen 03 medical and health sciences 030104 developmental biology 0302 clinical medicine Oncology 030220 oncology & carcinogenesis medicine Cancer research Humans CTLA-4 Antigen Pharmacology (medical) Immunotherapy business Immune Checkpoint Inhibitors |
| Zdroj: | Journal of Oncology Pharmacy Practice. 27:207-211 |
| ISSN: | 1477-092X 1078-1552 |
| DOI: | 10.1177/1078155220921543 |
| Popis: | Introduction Immune agents including anti-programmed death receptor-1 and anti-cytotoxic T-lymphocyte antigen-4 have been associated with numerous immune-related complications. Pembrolizumab, a programmed death-1 inhibitor, has been associated with a number of immune-related adverse events such as pneumonitis, colitis, hepatitis, hypophysitis, hyperthyroidism, hypothyroidism, nephritis, and type 1 diabetes. Case report We present a rare case of an elderly male on pembrolizumab who suffered from four autoimmune toxicities including type 1 diabetes, pneumonitis, hypothyroidism, and polymyalgia rheumatica likely catalyzed by age-related immune activation. Management and outcome: Immunotherapy was indefinitely stopped, and patient was started on steroids for the immune-related adverse events with complete resolution of polymyalgia rheumatica. Thyroid dysfunction resolved once he started thyroid replacement therapy. His diabetes is well controlled with insulin and is followed by endocrinology. He continues on prednisone for immune-mediated pneumonitis with a good response with regular monitoring via computed tomography scans and pulmonary consultation. Discussion Few cases wherein multiple toxicities are seen within one patient are reported. Aging appears to be a risk factor for immune-related adverse events. Aging is associated with an increased incidence of autoimmunity as programmed death-1 ligand expression represents an important mechanism that tissues use to protect from self-reactive effector T cells. Programmed death-1 blockade breaks this protective mechanism and enhances autoimmune diseases. Therefore, close monitoring and extreme vigilance is warranted while using immune checkpoint inhibitors including pembrolizumab as multiple toxicities can occur within a short span of infusion, especially in elderly individuals. Prompt discontinuation and the use of a multidisciplinary team are prudent to prevent further morbidity and mortality. |
| Databáze: | OpenAIRE |
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