Cytokine Release Syndrome Induced by Immune-checkpoint Inhibitor Therapy for Non-small-cell Lung Cancer

Abstract

Immune-related adverse events, including autoimmune toxicity, may develop as a consequence of immune-checkpoint inhibitor (ICI) cancer therapy. Cytokine release syndrome (CRS) is a severe and life-threatening cytokine-associated toxicity that can develop after adoptive T-cell therapy. We herein report a rare case of severe CRS after ICI therapy for advanced non-small-cell lung cancer. He presented with a prolonged high fever, cardiogenic shock, and disseminated intravascular coagulation after the first course of programed death ligand-1 inhibitor and platinum-based doublet chemotherapy. He recovered by steroid pulse therapy and tocilizumab. CRS is a rare but life-threatening adverse event of ICI therapy and therefore warrants awareness.

Keywords: cytokine release syndrome; immune-checkpoint therapy; tocilizumab.

Figure 1.

Changes in CRP and IL-6 levels. CRP: C-reactive protein, IL-6: interleukin 6

Figure 2.

a: Adrenal metastasis before chemotherapy. b: Primary lesion of the lung before chemotherapy. c: Adrenal metastasis on day 57. d: Primary lesion of the lung on day 57.