Pembrolizumab-related Immune Thrombocytopenia in a Patient with Lung Adenocarcinoma Treated by Radiotherapy: Potential Immune-related Adverse Event Elicited by Radiation Therapy

The effect of radiotherapy during immunotherapy on immune-related adverse events (irAEs) is not fully understood. We herein report a 74-year-old woman diagnosed with lung adenocarcinoma with programmed death ligand 1 expression ≥50% and treated with pembrolizumab. She developed fatal immune thromboc...

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Bibliographic Details
Published in:Internal Medicine 2022/06/01, Vol.61(11), pp.1731-1734
Main Authors: Tamanoi, Daisuke, Saruwatari, Koichi, Imamura, Kosuke, Sato, Ryo, Jodai, Takuya, Hamada, Shohei, Tomita, Yusuke, Saeki, Sho, Ueno, Shikiko, Yonemura, Yuji, Ichiyasu, Hidenori, Sakagami, Takuro
Format: Article
Language:English
Subjects:
Adenocarcinoma
Adenocarcinoma of Lung - drug therapy
Adenocarcinoma of Lung - radiotherapy
Aged
Antibodies, Monoclonal, Humanized
Antineoplastic Agents, Immunological - adverse effects
Apoptosis
Case Report
CD4 antigen
CD8 antigen
CD8-Positive T-Lymphocytes
Female
Flow cytometry
Humans
Idiopathic thrombocytopenic purpura
immune-related adverse effects
Immunosuppressive agents
Immunotherapy
Internal medicine
Lung Neoplasms - drug therapy
Lung Neoplasms - radiotherapy
Lymphocytes T
non-small-cell lung cancer
Patients
PD-1
PD-1 protein
Pembrolizumab
Peripheral blood
Purpura, Thrombocytopenic, Idiopathic - chemically induced
Purpura, Thrombocytopenic, Idiopathic - drug therapy
Radiation therapy
stereotactic radiotherapy
Thrombocytopenia - chemically induced
Thrombocytopenia - drug therapy
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Summary:The effect of radiotherapy during immunotherapy on immune-related adverse events (irAEs) is not fully understood. We herein report a 74-year-old woman diagnosed with lung adenocarcinoma with programmed death ligand 1 expression ≥50% and treated with pembrolizumab. She developed fatal immune thrombocytopenia associated with pembrolizumab immediately following radiotherapy. A flow cytometry analysis of peripheral blood detected an increased expression of programmed death-1 (PD-1) and Ki-67 in CD4+ and CD8+ T cells after radiotherapy, compared with pre-irradiation measurements. This case suggests that radiotherapy may evoke irAEs during treatment with anti-PD-1 antibodies, which physicians should consider when using radiotherapy in patients treated with these drugs.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.7581-21