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Tumor Treating Field Therapy in Combination with Bevacizumab for the Treatment of Recurrent Glioblastoma

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Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy.

Si Li¹, Nishant Sharma¹, Daniel Kazmierski¹

¹Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA.

|July 26, 2021

Summary

Immune checkpoint inhibitors can cause lung damage, complicating cancer treatment. This case highlights diffuse alveolar hemorrhage (DAH) as a rare but serious side effect of avelumab therapy in urothelial carcinoma patients.

Keywords:

acute hypoxemic respiratory failure diffuse alveolar hemorrage ground-glass opacity immune check-point inhibitor urothelial malignancy

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Published on: June 23, 2019

Area of Science:

Oncology
Immunotherapy
Pulmonology

Background:

Immune checkpoint blockade is a significant advancement in cancer therapy.
Adverse events from immune checkpoint inhibitors (ICIs) are diverse and can mimic other conditions.
Pneumotoxicity is a known complication of ICIs, posing diagnostic challenges, especially with overlapping symptoms from infections like COVID-19.

Observation:

A patient with metastatic urothelial carcinoma received treatment with avelumab, an immune checkpoint inhibitor.
The patient subsequently developed symptoms suggestive of lung injury.

Findings:

The patient presented with diffuse alveolar hemorrhage (DAH), a severe form of lung toxicity.
DAH occurred in the context of avelumab treatment for urothelial carcinoma.

Implications:

This case underscores the importance of recognizing DAH as a potential immune-related adverse event (irAE) associated with avelumab.
Early diagnosis and management of ICI-induced pneumotoxicity are crucial for patient outcomes.
The complexity of diagnosing ICI-related lung injury necessitates a high index of suspicion, particularly in patients with pre-existing respiratory conditions or during pandemics.