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Case Reports
. 2018 May;97(20):e10772.
doi: 10.1097/MD.0000000000010772.

Pembrolizumab-induced acute thrombosis: A case report

Kei Kunimasa  1 , Kazumi Nishino, Madoka Kimura, Takako Inoue, Motohiro Tamiya, Toru Kumagai, Fumio Imamura
Affiliations
Case Reports

Pembrolizumab-induced acute thrombosis: A case report

Kei Kunimasa et al. Medicine (Baltimore). 2018 May.

Abstract

Rationale: Acute thrombosis has not been reported in the literature so far in lung cancer patients as an immune-related adverse event (irAE) associated with PD-1 pathway inhibitors.

Patients concerns: Here, we for the first time present two NSCLC (non-small cell lung cancer) patients suffering from acute thrombosis as a pembrolizumab-induced irAE. Immediate treatment with continuous heparin infusion improved their symptoms and enabled them to continue pembrolizumab administration.

Methods: Ethical approval was given by the ethics committee of Osaka International Cancer Institute and the informed consents were given by the patients.

Diagnosis: Serum D-dimer level testing, venous ultrasonography, enhanced computed tomography (CT).

Interventions: Continuous heparin infusion, direct oral anticoagulants (DOAC).

Outcomes: Immediate continuous heparin infusion improved their symptoms and continuing pembrolizumab with direct oral anticoagulant successfully induced tumor shrinkage.

Lessons: Reinvigoration of exhausted T cells by pembrolizumab induced systemic inflammation possibly resulting in development of thrombosis. Although acute thrombosis is a rare irAE, it may lead to cessation of treatment and can be lethal.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: Dr Imamura reports personal fees from Ono pharmaceutical co., Ltd, personal fees from MSD, personal fees from Bristol-Myers Squibb, outside the submitted work. Other authors have no COI.

Figures

Figure 1
Figure 1
Chest-enhanced CT images; (A) Before pembrolizumab administration (B) On day 7 after administration. Yellow arrow indicates enhancement defect suggesting thrombus formation in the left pulmonary artery. CT = computed tomography.
Figure 2
Figure 2
Chest-enhanced CT images; (A) Before pembrolizumab administration (B) After 3 courses of administration. CT = computed tomography.
See this image and copyright information in PMC

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