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Pembrolizumab-induced acute thrombosis: A case report
Kei Kunimasa1, Kazumi Nishino, Madoka Kimura
1Department of Thoracic Oncology, Osaka International Cancer Institute, Otemae Chuoku, Osaka City, Japan.
Medicine
|May 17, 2018
Summary
Acute thrombosis is a rare immune-related adverse event (irAE) in lung cancer patients treated with PD-1 inhibitors like pembrolizumab. Early heparin treatment managed symptoms, allowing continued therapy and tumor shrinkage.
Area of Science:
- Oncology
- Immunology
- Vascular Medicine
Background:
- Immune-related adverse events (irAEs) are known complications of PD-1 pathway inhibitors.
- Acute thrombosis has not been previously reported as an irAE in lung cancer patients receiving these therapies.
Observation:
- Two non-small cell lung cancer (NSCLC) patients developed acute thrombosis during pembrolizumab treatment.
- Diagnosis was confirmed via D-dimer testing, venous ultrasonography, and enhanced CT scans.
Findings:
- Immediate treatment with continuous heparin infusion resolved thrombosis symptoms.
- Patients successfully continued pembrolizumab therapy combined with direct oral anticoagulants (DOACs), achieving tumor shrinkage.
Implications:
- Pembrolizumab-induced T-cell activation may trigger systemic inflammation, leading to thrombosis.
- Recognizing and managing this rare irAE is crucial to prevent treatment cessation and potential mortality.
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