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Integrated Traditional Chinese and Western Medicine for Severe Tislelizumab-Induced Rash: A Case Report
Boya Wang1, Yan Zhang1, Jianglin Wu2
1Guizhou University of Traditional Chinese Medicine, Guiyang, China.
Introduction:
Programmed death receptor 1 inhibitors are widely used tumor immunotherapy agents, yet they frequently trigger immune-related adverse events (irAEs), among which severe cutaneous toxicities are life-threatening and often interrupt anti-tumor treatment. Conventional Western medicine relying on glucocorticoids carries notable side effects, while integrated traditional Chinese medicine and Western medicine (TCM-WM) offers a promising alternative therapeutic strategy. This work aims to explore the clinical efficacy and safety of combined TCM-WM intervention for severe tislelizumab-induced cutaneous irAEs, elaborate traditional Chinese medicine (TCM) syndrome differentiation logic, and accumulate clinical evidence for managing such severe skin adverse reactions.
Case Presentation:
A 71-year-old male patient with right lung squamous cell carcinoma complicated by supraclavicular lymph node metastasis developed grade 3 severe cutaneous irAE after tislelizumab immunotherapy, diagnosed with TCM syndrome of intermingled damp-heat, stasis, and toxin. Comprehensive Western medicine treatment (glucocorticoids, antihistamines, topical anti-inflammatory ointments, and analgesics) combined with individualized oral modified TCM granules, external herbal washing, and characteristic TCM therapies was implemented. After 12 days of inpatient treatment and 3 months of continuous follow-up, the patient's severe rash, skin pain, and pruritus were fully resolved without recurrence. The duration of intravenous glucocorticoid administration was shortened to only 7 days followed by oral tapering, and no significant adverse reactions occurred during the whole treatment course.
Conclusion:
Integrated TCM-WM demonstrates synergistic efficacy in the treatment of severe tislelizumab-induced cutaneous irAEs by regulating immune balance and eliminating pathogenic factors. It provides a valuable therapeutic option for such patients and warrants further validation in larger sample studies.
