- مبلغ: ۸۶,۰۰۰ تومان
- مبلغ: ۹۱,۰۰۰ تومان
Introduction: Nivolumab is a programmed death 1 (PD-1) immune-checkpoint inhibitor antibody currently approved for second-line therapy of metastatic non-small-cell lung cancer (NSCLC). PD-1 inhibitors including nivolumab are associated with a unique spectrum of immune-related adverse events (irAEs), though hematologic irAEs are rare and have not been previously reported in patients with NSCLC. Presentation of case: Here we report a patient who experienced an exacerbation of underlying immune thrombocytopenia (ITP) while receiving nivolumab for NSCLC. The patient's ITP was successfully managed with romiplostim during nivolumab therapy, allowing for 7 months of clinical benefit and a partial tumor response. Discussion: Using this case as an example, we provide a brief review of irAEs associated with PD-1 blockade, with particular attention to hematologic events. We also describe our approach to the use of nivolumab in this patient with underlying autoimmune disease. Conclusion: Patients with NSCLC and underlying autoimmune disease may experience a flare of the autoimmune condition while receiving immune checkpoint inhibition. As illustrated by this case of ITP exacerbated by nivolumab, careful management of the autoimmune disease may allow for the safe administration of PD-1 directed agents in these patients.
In summary, though de novo hematologic irAEs are rare with PD-1 blockade, this case illustrates that preexisting ITP can be exacerbated by nivolumab. In this case, the worsened thrombocytopenia did not result in bleeding and was successfully managed with romiplostim. PD-1 blockade is now the standard of care for second-line therapy of advanced/metastatic NSCLC, and patients with underlying autoimmune conditions should not automatically be denied an opportunity to benefit from these drugs on the basis of a theoretical risk of an autoimmune disease flare. Rather, clinicians should discuss the possible benefits and risks of immunologic checkpoint blockade with these patients on an individual basis.