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Association of Programmed Cell Death 1 Inhibitor with Circumorificial Plasmacytosis

Yusuf Tanimu1, Reilly Coombs2, Sabo Tanimu3

  • 1Internal Medicine, Marshfield Clinic Health System, Marshfield, WI, USA.

Case Reports in Oncology
|January 8, 2024
PubMed
Abstract

Insights

Pembrolizumab, a PD-1 inhibitor, can cause immune-related adverse events like oral lesions. This case shows a patient with thymic carcinoma who developed bleeding oral lesions after long-term pembrolizumab treatment.

Area of Science:

  • Oncology
  • Immunotherapy
  • Dermatology

Background:

  • Immune checkpoint inhibitors, such as pembrolizumab targeting programmed death-1 (PD-1) receptors, represent a significant advancement in cancer therapy.
  • Pembrolizumab exhibits efficacy across various malignancies, including non-small cell lung cancer, melanoma, and triple-negative breast cancer.
  • Immune-related adverse events (irAEs), particularly mucosal and cutaneous reactions, are common side effects of pembrolizumab, potentially impacting treatment adherence and quality of life.

Observation:

  • A 27-year-old male patient with stage IVB thymic carcinoma presented with extensive lymphadenopathy and a mediastinal mass.
  • The patient received 53 cycles of pembrolizumab over 39 months.
  • Bleeding oral lesions emerged approximately 38 months into pembrolizumab therapy.

Findings:

  • The patient developed oral lesions, a type of immune-related adverse event, late in the course of pembrolizumab treatment.
  • The oral lesions were characterized as bleeding and perioral.
  • Steroid treatment led to the improvement of the perioral rash.

Implications:

  • This case highlights the potential for delayed onset of irAEs, such as oral mucositis, even after prolonged pembrolizumab administration.
  • Understanding the spectrum and timing of pembrolizumab toxicities is crucial for effective patient management and treatment continuation.
  • Prompt recognition and management of irAEs, including the use of corticosteroids, can help mitigate side effects and maintain therapeutic benefit.
Keywords:
Checkpoint inhibitorsCircumorificial plasmacytosisImmunotherapy side effectsPembrolizumabThymic carcinoma

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