Eosinophilic Asthma Secondary to Adjuvant Anti-PD-1 Immune Checkpoint Inhibitor Treatment in a Melanoma Patient.

IF 0.6 Q4 ONCOLOGY
P Kissoonsingh, B Sutton, Syed U Iqbal, Lalit Pallan, Neil Steven, L Khoja
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引用次数: 5

Abstract

Background: Adjuvant immune checkpoint inhibitors are a new standard of care in melanoma. However, the immune related toxicity associated with these agents can be serious, and the long-term implications are yet to be defined especially in the adjuvant setting. We report, to our knowledge, the first case of anti-PD-1-induced eosinophilic asthma in a melanoma patient treated with adjuvant pembrolizumab. Case Presentation. A 72-year-old man commenced pembrolizumab in the adjuvant setting after resection of a stage IIIB cutaneous melanoma. The patient experienced episodes of breathlessness 4 weeks after cycle 1. These episodes were nocturnal and caused acute respiratory distress and cough, occasionally waking him up. The episodes progressed, and he was admitted after cycle 2 with a productive cough, wheeze, and breathlessness. Observations showed saturations on air of 94% and a respiratory rate of 19/min. The only laboratory abnormality was a raised eosinophil count of 1.1 × 109. Spirometry showed a FEV1 of 2.57 (91% predicted), FVC of 4.04 (108% predicted), and ratio of 64%. Peak expiratory flow rate was 94% predicted, and corrected gas transfer was 6.29 (78% predicted) with KCO 1.18 (93% predicted). FeNO was raised at 129 indicating inflammation of his airways, and peak flow was 422 l/min. CT of the chest did not show pneumonitis or other lung pathology. A diagnosis of acute eosinophilic asthma was made. Treatment with steroids and beclometasone dipropionate and formoterol inhaler produced rapid resolution of symptoms and normalisation of the eosinophil count. Pembrolizumab was safely recommenced once steroids had discontinued and symptoms had resolved.

Conclusions: Specialist respiratory input was needed for optimal patient management and is ongoing. Although a safe rechallenge with pembrolizumab was possible, treatment in the adjuvant setting is curative in intent and long-term safety follow-up is required to assess for delayed toxicity and long-term health implications. This is likely to require large regional/national/international databases to detect, monitor, and educate the wider medical community as these patients are followed up in primary care following initial specialist follow-up.

Abstract Image

Abstract Image

黑色素瘤患者辅助抗pd -1免疫检查点抑制剂治疗继发嗜酸性哮喘
背景:辅助免疫检查点抑制剂是黑色素瘤治疗的新标准。然而,与这些药物相关的免疫相关毒性可能是严重的,长期影响尚未确定,特别是在佐剂设置中。我们报告,据我们所知,第一例抗pd -1诱导嗜酸性粒细胞哮喘的黑色素瘤患者接受辅助治疗派姆单抗。案例演示。一名72岁男性在IIIB期皮肤黑色素瘤切除术后开始使用派姆单抗作为辅助治疗。患者在第1周期后4周出现呼吸困难发作。这些发作发生在夜间,引起急性呼吸窘迫和咳嗽,偶尔惊醒他。发作进展,患者在第2周期后因咳嗽、喘息和呼吸困难入院。观察显示空气饱和度为94%,呼吸速率为每分钟19次。唯一的实验室异常是嗜酸性粒细胞计数升高1.1 × 109。肺活量测定显示FEV1为2.57(预测91%),FVC为4.04(预测108%),比值为64%。预测呼气流量峰值为94%,校正气体传递为6.29(预测78%),KCO为1.18(预测93%)。FeNO升高至129,表明气道炎症,峰值流量为422 l/min。胸部CT未见肺炎或其他肺部病变。诊断为急性嗜酸性哮喘。用类固醇、二丙酸倍氯米松和福莫特罗吸入器治疗可迅速缓解症状并使嗜酸性粒细胞计数恢复正常。一旦类固醇停用且症状消退,派姆单抗可以安全地重新使用。结论:需要专科呼吸输入以优化患者管理,并且正在进行中。尽管使用派姆单抗进行安全的再挑战是可能的,但辅助治疗的目的是治愈性的,需要长期的安全性随访来评估延迟毒性和长期健康影响。这可能需要大型的区域/国家/国际数据库来发现、监测和教育更广泛的医疗界,因为这些患者在最初的专家随访之后在初级保健中进行随访。
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来源期刊
自引率
0.00%
发文量
11
审稿时长
16 weeks
期刊介绍: Case Reports in Oncological Medicine is a peer-reviewed, Open Access journal that publishes case reports and case series related to breast cancer, lung cancer, gastrointestinal cancer, skin cancer, head and neck cancer, paediatric oncology, neurooncology as well as genitourinary cancer.
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