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Review
. 2021 Sep;13(13):1071-1078.
doi: 10.2217/imt-2020-0329. Epub 2021 Jul 21.

Delayed cytokine release syndrome after neoadjuvant nivolumab: a case report and literature review

Aaron T Ciner  1 , Howard S Hochster  1 , David A August  1 , Darren R Carpizo  2 , Kristen R Spencer  1
Affiliations
Review

Delayed cytokine release syndrome after neoadjuvant nivolumab: a case report and literature review

Aaron T Ciner et al. Immunotherapy. 2021 Sep.

Abstract

Aim: Cytokine release syndrome (CRS) is an infrequently described immune-related adverse event of checkpoint inhibitors (CPI). CPI-induced CRS typically presents with fevers, hemodynamic instability and organ dysfunction within 2 weeks of the last treatment cycle. Case study: We report an unusual case of delayed and severe CRS occurring postoperatively in a patient with hepatic-limited metastatic colorectal cancer who received neoadjuvant immunotherapy. After a negative workup for alternative causes, he received prolonged corticosteroid treatment with symptom resolution. Conclusion: CPI-induced CRS can mimic sepsis and clinicians should maintain a high-index of suspicion to diagnose this immune-related adverse event early and initiate appropriate treatment. As use of perioperative immunotherapy increases, the potential role of surgery to trigger CRS in this case warrants further investigation.

Keywords: colorectal cancer; cytokine release syndrome; immunotherapy; neoadjuvant treatment; surgical-induced inflammation.

Plain language summary

Lay abstract Aim: Cytokine release syndrome (CRS) is a rare but potentially serious side effect of a class of immunotherapy drugs called checkpoint inhibitors (CPI). CRS typically presents with fevers and low blood pressure and can cause damage to organs including the kidneys and liver. Case study: We report an unusual case of severe CRS occurring after surgery in a patient who had received prior CPI therapy. After a thorough evaluation for alternative causes, he was diagnosed with CRS and treated successfully with steroids. Conclusion: It is important for medical providers to consider this potential side effect when treating patients with CPI. Further research is needed to clarify the role of surgery in CPI-induced CRS.

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Conflict of interest statement

Financial & competing interests disclosure

D Carpizo is NIH funded. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Patient clinical course.
Day 0 = day of surgery – 4 months after initiation of neoadjuvant nivolumab and CV301 and 6 weeks since last dose. (+): Positive result T2 PCR; (b): Blood; (h): Heptic fluid collection; X: Negative bacterial culture; Y: Negative fungal blood culture.
See this image and copyright information in PMC

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