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Pembrolizumab-induced agranulocytosis
Víctor Fernández Martínez1, Adela García-Avello Fernández-Cueto1, Carmen María Valencia Soto1
1Pharmacy Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Summary
Pembrolizumab, a common cancer immunotherapy, can cause rare but fatal agranulocytosis. This case highlights the critical need for vigilance and prompt reporting of severe immune-related adverse events in patients receiving immune checkpoint inhibitors.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Immune checkpoint inhibitors, such as anti-programmed death-1 (PD-1) monoclonal antibodies like pembrolizumab, are increasingly used in cancer therapy.
- While effective, these therapies can be associated with rare but serious immune-related adverse events (irAEs).
Observation:
- A patient with stage IVB non-keratinizing squamous lung carcinoma and high PD-L1 expression received pembrolizumab monotherapy.
- Ten days after a single dose, the patient developed grade 4 neutropenia, progressing to agranulocytosis with neutropenic fever, mucositis, and anemia.
Findings:
- Despite immediate pembrolizumab discontinuation and standard treatments including granulocyte colony-stimulating factor, corticosteroids, and immunoglobulins, the patient's condition rapidly worsened.
- The patient died three weeks after admission, with a possible causal link established between pembrolizumab and agranulocytosis.
Implications:
- Hematologic irAEs, including agranulocytosis and neutropenia, are infrequent but potentially life-threatening complications of immune checkpoint inhibitor therapy.
- Management requires prompt recognition and aggressive treatment, with careful consideration of risks versus benefits before re-challenging with immunotherapy.
- Reporting rare adverse drug reactions to pharmacovigilance systems is crucial for understanding and mitigating the risks associated with these powerful therapies.
