Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report.

IF 1.2 Q4 PHARMACOLOGY & PHARMACY
Tatsuhiro Fujimiya, Kanako Azuma, Yuki Togashi, Koji Kuwata, Sakae Unezaki, Hironori Takeuchi
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Abstract

Background: Pembrolizumab can cause immune-related adverse events such as adrenal insufficiency (AI). However, there is no consensus regarding appropriate monitoring of adrenal function during subsequent chemotherapy in patients who have received immune checkpoint inhibitors (ICIs) such as pembrolizumab.

Case presentation: In this report, we discuss the case of a 60s-year-old male patient with non-small cell lung cancer receiving chemotherapy who developed secondary AI due to adrenocorticotrophic hormone (ACTH) deficiency 8 months after the discontinuation of pembrolizumab, which was 17 months after the initiation of pembrolizumab immunotherapy. After 5 months of chemotherapy, he developed fever and diarrhoea, after which chemotherapy was discontinued. Thereafter, he was hospitalised owing to the development of general fatigue and anorexia. Although cortisol and ACTH levels were not measured during chemotherapy, they were measured before hospitalisation, and secondary AI was suspected. After admission, a detailed endocrine workup was performed, and the patient was diagnosed with secondary AI due to ACTH deficiency. Treatment with hydrocortisone was initiated, which markedly improved his general fatigue and anorexia. The patient showed no evidence of progressive disease 9 months after the discontinuation of pembrolizumab.

Conclusions: Although rare, the possibility of AI should be considered in patients who have received ICIs when nonspecific symptoms develop during or after subsequent chemotherapy, and measurements of endocrine function (including cortisol and ACTH levels) should be performed.

非小细胞肺癌患者肾上腺皮质激素缺乏导致的 Pembrolizumab 引起的继发性肾上腺功能不全:病例报告。
背景Pembrolizumab 可导致免疫相关不良事件,如肾上腺功能不全(AI)。然而,对于接受免疫检查点抑制剂(ICIs)(如 Pembrolizumab)治疗的患者在后续化疗期间肾上腺功能的适当监测,目前尚未达成共识:在本报告中,我们讨论了一例接受化疗的 60 多岁男性非小细胞肺癌患者,他在停用 Pembrolizumab 8 个月后因肾上腺皮质激素(ACTH)缺乏而出现继发性 AI,此时距离 Pembrolizumab 免疫疗法的开始已有 17 个月。化疗 5 个月后,他出现发烧和腹泻,随后化疗停止。此后,他因全身乏力和厌食而住院治疗。虽然在化疗期间没有测量皮质醇和促肾上腺皮质激素水平,但在住院前进行了测量,并怀疑有继发性 AI。入院后,医生对患者进行了详细的内分泌检查,确诊患者因缺乏促肾上腺皮质激素(ACTH)而患有继发性 AI。患者开始接受氢化可的松治疗,这明显改善了他的全身乏力和厌食症状。停用彭博利珠单抗9个月后,患者没有出现疾病进展的迹象:尽管罕见,但接受过 ICIs 治疗的患者在化疗期间或化疗后出现非特异性症状时,应考虑到 AI 的可能性,并应测量内分泌功能(包括皮质醇和促肾上腺皮质激素水平)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
29
审稿时长
8 weeks
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