Open AccessPembrolizumab-induced acute thrombosis
Author(s) -
Kei Kunimasa,
Kazumi Nishino,
Masashi Kimura,
Tomio Inoue,
Motohiro Tamiya,
Toru Kumagai,
Fumio Imamura
Publication year - 2018
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000010772
Subject(s) - medicine , pembrolizumab , heparin , thrombosis , adverse effect , venous thrombosis , cancer , lung cancer , intensive care medicine , immunotherapy
Abstract Rationale: 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. Patients concerns: 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. Methods: Ethical approval was given by the ethics committee of Osaka International Cancer Institute and the informed consents were given by the patients. Diagnosis: Serum D-dimer level testing, venous ultrasonography, enhanced computed tomography (CT). Interventions: Continuous heparin infusion, direct oral anticoagulants (DOAC). Outcomes: Immediate continuous heparin infusion improved their symptoms and continuing pembrolizumab with direct oral anticoagulant successfully induced tumor shrinkage. Lessons: 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.