Aprepitant for refractory nivolumab-induced pruritus.

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICIs) have advanced non-small-cell lung cancer (NSCLC) treatment.
• Severe immune-related adverse events (irAEs) can complicate ICI therapy.

Observation:

• A 76-year-old Japanese woman with advanced NSCLC developed severe rash and mucous membrane involvement after nivolumab treatment.
• This was diagnosed as Stevens-Johnson syndrome (SJS), treated with oral prednisolone.
• Despite rash resolution, severe pruritus persisted and was refractory to standard treatments (emollients, antihistamines, steroids).

Findings:

• Aprepitant, a neurokinin-1 receptor antagonist, was administered for the refractory pruritus.
• The patient's pruritus significantly improved within 5 days of aprepitant treatment.

Implications:

• Severe refractory pruritus is a potential irAE of ICIs in NSCLC patients.
• Aprepitant shows promise as an effective treatment for this debilitating symptom.
• This case highlights the need for novel therapeutic strategies for managing irAEs.