A Non-small Cell Lung Cancer Patient Who Was Successfully Resuscitated After Cardiac Arrest Caused by Infusion-related Reaction with Carboplatin, Paclitaxel, Nivolumab, and Ipilimumab Therapy

Abstract

━━ Background. Two cycles of chemotherapy and nivolumab, an anti-PD-1 antibody, and ipilimumab, an anti-CTLA-4 antibody, have been used as the standard therapy for advanced or recurrent non-small cell lung cancer. Clinical trials have demonstrated a significantly higher overall survival with this combination than with chemotherapy alone. However, the management of adverse events is important, as with any other regimen. Case. A 61-year-old man complaining of dyspnea was diagnosed with right upper lobe non-small cell lung cancer (cT4N2M0 cStage IIIB, PD-L1 TPS 15%). Combination therapy of carboplatin, paclitaxel, nivolumab, and ipilimumab was started, and by day 10 of treatment, the tumor had clearly shrunk on chest radiographs. During day 22 of the administration of nivolumab, the patient experienced generalized erythema and nasal obstruction, which was determined to be an infusion-related reaction (IRR) grade 2. Hydrocortisone and H1 and H2 blockers were ad-ministered, and the patientʼs symptoms rapidly improved. Immediately after restarting nivolumab, the patient experienced wheezing, hypotension, and loss of consciousness, leading to cardiopulmonary arrest. The patient did not respond to repeated intravenous adrenaline administration; therefore, he was intubated and placed on an extracorporeal membrane artificial lung (V-A ECMO), which resulted in the resumption of his pulse. Subsequently, the patient was treated with steroids and discharged without any significant complications. Conclusions. Al-though the frequency of grade ≥ 3 IRR is quite low with this combination treatment, clinicians should be aware that it remains a distinct possibility.