Anlotinib improved the reactive cutaneous capillary endothelial proliferation induced by camrelizumab: a case report

Abstract

Background: Programmed cell death protein-1 (PD-1) or its ligand PD-L1 monoclonal antibodies, opening a new era of tumor immunotherapy, and they have significantly improved the overall survival of many patients with advanced solid tumors. However, in addition to its effectiveness, we should also pay attention to its adverse effects. The instructions of the PD-1 inhibitor camrelizumab clearly indicate that reactive cutaneous capillary endothelial proliferation (RCCEP) is the most common adverse reaction; it is common for many immune checkpoint inhibitors (ICIs). Here we describe a case that anlotinib improved RCCEP induced by anti-PD-1 blockade camrelizumab with some focus on further management of this symptoms.

Case description: A 57-year-old man with squamous cell carcinoma of the upper lobe of the left lung, and with mediastinal lymphocyte and liver metastasis, received the fifth cycle of chemotherapy and immunotherapy with camrelizumab (200 mg, every 3 weeks). Four days after treatment with camrelizumab, the patient's face, head, neck, and chest skin had multiple scattered bright red round papules, which were diagnosed as RCCEP. The patient was treated with oral anlotinib (8 mg, once a day). After 5 days of treatment, the symptoms of RCCEP gradually eased, and the patient was discharged.

Conclusions: In conclusion, we have reported a case of RCCEP induced by anti-PD-1 blockade camrelizumab. The patient was given oral anlotinib to relieve the symptoms of RCCEP. Suggesting that anlotinib could be a potential management to reduce the adverse reactions who are treated with camrelizumab. The risk for RCCEP should always be kept in mind during camrelizumab treatment.

Keywords: Camrelizumab; anlotinib; case report; programmed cell death protein-1 (PD-1); reactive cutaneous capillary endothelial proliferation (RCCEP).

Figure 1

Substantial space-occupying lesions at the bronchial opening of the upper lobe of the left lung. Lobulation can be seen at the edge, and the bronchial opening of the upper lobe of the left lung is narrow and occluded. The lesions were significantly improved on 31 August 2021 (B) compared with 22 June 2021 (A). The yellow arrows indicated the lesions.

Figure 2

RCCEP induced by anti-PD-1 blockade camrelizumab. (A) RCCEP was located on the scalp and trunk of the patient. (B) A rash was under the left eye of the patient, which ruptured and bled. The black arrows indicated the RCCEP. This image is published with the patient consent. RCCEP, reactive cutaneous capillary endothelial proliferation.