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Pembrolizumab-related Immune Thrombocytopenia in a Patient with Lung Adenocarcinoma Treated by Radiotherapy: Potential Immune-related Adverse Event Elicited by Radiation Therapy
Authors:Daisuke Tamanoi  Koichi Saruwatari  Kosuke Imamura  Ryo Sato  Takuya Jodai  Shohei Hamada  Yusuke Tomita  Sho Saeki  Shikiko Ueno  Yuji Yonemura  Hidenori Ichiyasu  Takuro Sakagami
Affiliation:1.Department of Respiratory Medicine, Kumamoto University Hospital, Japan; 2.Department of Hematology, Rheumatology and Infectious Disease, Kumamoto University Hospital, Japan; 3.Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Japan
Abstract: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.
Keywords:non-small-cell lung cancer   immunotherapy   PD-1   stereotactic radiotherapy   immune-related adverse effects
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