Cytokine release syndrome in non- small cell lung cancer patient receiving immune checkpoint inhibitors: A case report

Abstract

Cytokine release syndrome (CRS) is a well-described immune-related adverse event following chimeric antigen receptor T-cell therapy (CAR-T) but has rarely been reported following therapy with immune checkpoint inhibitors (ICI).

We present a clinical case of severe CRS after ICI therapy for advanced non-small-cell lung cancer (NSCLC). After the third cycle of ipilimumab and nivolumab the patient presented with fever, hypotension and somnolence, leading to acute respiratory failure, acute kidney and hepatic failure, capillary leak syndrome, requiring ICU (intensive care unit) care. She recovered after receiving tocilizumab and steroid therapy.

Subsequently, we found 17 clinical cases of advanced NSCLC patients in peer review, experiencing CRS as an adverse event of treatment with ICI. We review those cases in detail and compare the similarities and outcomes.

Conclusion: CRS is a serious, life-threatening complication that is rare after ICI therapy for solid cancers but becoming increasingly frequent since ICI therapies are broadening indications. When presented with clinical symptoms, considering CRS is crucial, as early recognition is key to timely intervention and favorable outcome for the patient.