Pembrolizumab-induced acute thrombosis: A case report

Medicine
Kei KunimasaFumio Imamura

Abstract

Acute thrombosis has not been reported in the literature so far in lung cancer patients as an immune-related adverse event (irAE) associated with PD-1 pathway inhibitors. Here, we for the first time present two NSCLC (non-small cell lung cancer) patients suffering from acute thrombosis as a pembrolizumab-induced irAE. Immediate treatment with continuous heparin infusion improved their symptoms and enabled them to continue pembrolizumab administration. Ethical approval was given by the ethics committee of Osaka International Cancer Institute and the informed consents were given by the patients. Serum D-dimer level testing, venous ultrasonography, enhanced computed tomography (CT). Continuous heparin infusion, direct oral anticoagulants (DOAC). Immediate continuous heparin infusion improved their symptoms and continuing pembrolizumab with direct oral anticoagulant successfully induced tumor shrinkage. Reinvigoration of exhausted T cells by pembrolizumab induced systemic inflammation possibly resulting in development of thrombosis. Although acute thrombosis is a rare irAE, it may lead to cessation of treatment and can be lethal.

References

Jul 5, 2016·Lancet·Marcello Di NisioHarry R Büller
Oct 11, 2016·The New England Journal of Medicine·Martin ReckUNKNOWN KEYNOTE-024 Investigators
Apr 12, 2017·Nature·Alexander C HuangE John Wherry

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Citations

Dec 26, 2018·Clinical and Experimental Immunology·A PawłowskaI Wertel
May 28, 2019·Minerva medica·Giacomo CorradoGabriella Ferrandina
May 6, 2020·European Heart Journal Supplements : Journal of the European Society of Cardiology·Andrés J Muñoz MartínJosé Manuel Soria Fernández
Sep 7, 2019·South Asian Journal of Cancer·Waseem AbbasSwati Popli
Mar 29, 2020·Nature Reviews. Cardiology·Joerg Herrmann
May 27, 2021·Med·Joanna RoopkumarAlok A Khorana
Jul 9, 2021·Current Research in Translational Medicine·Daohong Chen
Dec 15, 2021·European Journal of Haematology·Abhishek GoelJoseph J Shatzel

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Methods Mentioned

BETA
biopsy

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