Immune checkpoint inhibitors (ICIs) have been extensively investigated as a novel
form of cancer therapy against a range of malignancies including urothelial carcinoma
[
[1]
]. Notably however, they have also been associated with unique toxicities known as
immune-related adverse events (irAEs) which may involve any organs, including haematologic
systems [
[2]
]. The precise mechanisms involved in different irAEs are largely unknown, but they
are believed to be associated with aberrant activation of immune systems induced by
ICIs. ICIs may activate T cell–mediated immunity as well as humoral immunity involving
autoantibodies, but the extent to which autoreactive T cells or autoantibodies contribute
to specific irAEs is not known and may differ in different organs and/or systems.
Herein, we describe a case of recurrent ICI-related thrombocytopenia in which two
sequential thrombocytopenia events occurred with distinct, but immune-related mechanisms
associated with pembrolizumab.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pembrolizumab as second-line therapy for advanced urothelial carcinoma.N Engl J Med. 2017; 376: 1015-1026
- Immune-related adverse events associated with immune checkpoint blockade.N Engl J Med. 2018; 378: 158-168
- Immature platelet fraction (IPF): a reliable tool to predict peripheral thrombocytopenia.Curr Res Transl Med. 2019; ([Epub ahead of print])https://doi.org/10.1016/j.retram.2019.04.002
- Safety and tolerability of PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer: a meta-analysis of randomized controlled trials.J Canc Res Clin Oncol. 2018; 144: 1851-1859
- Two cases of immune thrombocytopenia associated with pembrolizumab.Eur J Canc. 2016; 54: 172-174
- A case of immune thrombocytopaenia induced by pembrolizumab in a metastatic melanoma patient with a history of immune-mediated pure red cell aplasia.Eur J Canc. 2019; 110: 49-52
- Idiopathic thrombocytopenic purpura induced by nivolumab in a metastatic melanoma patient with elevated PD-1 expression on B cells.Ann Oncol. 2016; 27: 546-547
- Aplastic anemia.N Engl J Med. 2018; 379: 1643-1656
- Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline.J Clin Oncol. 2018; 36: 1714-1768
- Eltrombopag treatment for severe refractory thrombocytopenia caused by pembrolizumab.Eur J Canc. 2019; 121: 4-6
Article info
Publication history
Published online: March 28, 2020
Accepted:
February 13,
2020
Received:
January 12,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
