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Case Reports| Volume 50, ISSUE 2, P309-313, April 2023

Severe multiple simultaneous immune-related adverse events in a patient with head and neck cancer

Published:February 15, 2022DOI:https://doi.org/10.1016/j.anl.2022.02.002

      Abstract

      Nivolumab, an immune checkpoint inhibitor (ICI) against the programmed death-1 pathway, has been used for the treatment of recurrent metastatic head and neck cancer. However, the management of immune-related adverse events (irAEs), a unique side effect of ICI therapy, can be problematic. Although severe irAEs have been reported to result from multi-ICI therapy, we report a case of multiple severe irAEs caused by single-agent nivolumab treatment. Nivolumab was administered to treat a case of hypopharyngeal cancer recurrence. However, when first-line chemotherapy of nivolumab was replaced with a second chemotherapeutic agent because of insufficient effectiveness, the patient showed anorexia, dermatitis, and mucositis; upper gastrointestinal endoscopy yielded a diagnosis of irAEs. Additional examinations revealed simultaneous multiple irAEs, including hypothyroidism, dermatitis, eyelid conjunctivitis, tracheal mucositis, upper gastrointestinal ulcer, and type 1 diabetes. Since all symptoms improved after steroid treatment, the patient was treated with subsequent chemotherapy. However, he died from uncontrolled cancer recurrence. Thus, even a single ICI agent can cause life-threatening irAEs. Moreover, the management of irAEs requires early recognition and close multidisciplinary collaboration in accordance with the countermeasure manual.

      Keywords

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      References

        • Darnell EP
        • Mooradian MJ
        • Baruch EN
        • Yilmaz M
        • Reynolds KL.
        Immune-related adverse events (irAEs): Diagnosis, management, and clinical pearls.
        Curr Oncol Rep. 2020; 22: 39https://doi.org/10.1007/s11912-020-0897-9
        • Ferris RL
        • Blumenschein Jr G
        • Fayette J
        • Guigay J
        • Colevas AD
        • Licitra L
        • et al.
        Nivolumab for recurrent squamous-cell carcinoma of the head and neck.
        N Engl J Med. 2016; 375: 1856-1867https://doi.org/10.1056/NEJMoa1602252
        • von Itzstein MS
        • Khan S
        • Gerber DE.
        Investigational biomarkers for checkpoint inhibitor immune-related adverse event prediction and diagnosis.
        Clin Chem. 2020; 66: 779-793https://doi.org/10.1093/clinchem/hvaa081
        • Rogado J
        • Sánchez-Torres JM
        • Romero-Laorden N
        • Ballesteros AI
        • Pacheco-Barcia V
        • Ramos-Leví A
        • et al.
        Immune-related adverse events predict the therapeutic efficacy of anti-PD-1 antibodies in cancer patients.
        Eur J Cancer. 2019; 109: 21-27https://doi.org/10.1016/j.ejca.2018.10.014
        • Wang Y
        • Zhou S
        • Yang F
        • Qi X
        • Wang X
        • Guan X
        • et al.
        Treatment-related adverse events of PD-1 and PD-L1 inhibitors in clinical trials: a systematic review and meta-analysis.
        JAMA Oncol. 2019; 5: 1008-1019https://doi.org/10.1001/jamaoncol.2019.0393
        • Das S
        • Johnson DB.
        Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors.
        J Immunother Cancer. 2019; 7: 306https://doi.org/10.1186/s40425-019-0805-8
        • Kiyota N
        • Hasegawa Y
        • Takahashi S
        • Yokota T
        • Yen CJ
        • Iwae S
        • et al.
        A randomized, open-label, Phase III clinical trial of nivolumab vs. therapy of investigator's choice in recurrent squamous cell carcinoma of the head and neck: a subanalysis of Asian patients versus the global population in checkmate 141.
        Oral Oncol. 2017; 73: 138-146https://doi.org/10.1016/j.oraloncology.2017.07.023
        • Okamoto I
        • Sato H
        • Kondo T
        • Koyama N
        • Fushimi C
        • Okada T
        • et al.
        Efficacy and safety of nivolumab in 100 patients with recurrent or metastatic head and neck cancer - a retrospective multicentre study.
        Acta Oto-Laryngol. 2019; 139: 918-925https://doi.org/10.1080/00016489.2019.1648867
        • Schoenfeld AJ
        • Arbour KC
        • Rizvi H
        • Iqbal AN
        • Gadgeel SM
        • Girshman J
        • et al.
        Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib.
        Ann Oncol. 2019; 30: 839-844https://doi.org/10.1093/annonc/mdz077
        • EL Coleman
        • Olamiju B
        • Leventhal JS.
        The life-threatening eruptions of immune checkpoint inhibitor therapy.
        Clin Dermatol. 2020; 38: 94-104https://doi.org/10.1016/j.clindermatol.2019.10.015
        • Thompson JA
        • Schneider BJ
        • Brahmer J
        • Andrews S
        • Armand P
        • Bhatia S
        • et al.
        NCCN guidelines insights: management of immunotherapy-related toxicities, version 1.2020.
        J Natl Compr Canc Netw. 2020; 18 (version 1.2020): 230-241https://doi.org/10.6004/jnccn.2020.0012