Cytokine release syndrome induced by immune checkpoint inhibitor treatment for uterine cervical cancer recurrence: A case report

Abstract

Cytokine release syndrome (CRS) is a systemic inflammatory condition caused by an excessive immune response and cytokine overproduction. CRS is a life-threatening condition that is often associated with chimeric antigen receptor T-cell therapy. Despite the increased use of immune checkpoint inhibitors (ICIs), ICI-induced CRS remains rare. The present study describes a case of CRS that occurred after the administration of ICIs for recurrent adenocarcinoma of the uterine cervix. A 49-year-old woman received paclitaxel, carboplatin and pembrolizumab for recurrent cervical adenocarcinoma. On day 27 of the third cycle, the patient was admitted with a fever and suspected pyelonephritis. The following day, hypotension, upper respiratory symptoms and myalgia of the extremities were noted, and the left ventricular ejection fraction (LVEF) was decreased to 20%. Multiorgan failure (MOF) occurred, and the patient received ventilator support and continuous hemodiafiltration. Rhabdomyolysis, pancreatitis, erythema multiforme and enteritis were observed. CRS was diagnosed based on elevated ferritin and IL-6 levels. Steroid pulse therapy was administered; however, the MOF did not improve and the anti-IL-6-receptor monoclonal antibody tocilizumab (TOC) was administered. Subsequently, the LVEF improved to 50%, and the patient was removed from the ventilator on day 4 and from the continuous hemodiafiltration unit on day 6 after TOC administration. The patient was discharged on day 21. In conclusion, considering that ICI-induced CRS is a rare but severe complication, fever and other systemic conditions following ICI administration should be monitored.

Keywords: cytokine release syndrome; immune checkpoint inhibitor; immune-related adverse events; tocilizumab; uterine cervical cancer.

Figure 1.

Events during anticancer therapy and the main data from the laboratory test. TC, paclitaxel and carboplatin; Pem, pembrolizumab; CRP, C-reactive protein; Plt, platelet; Cre, creatinine; ICU, intensive care unit.

Figure 2.

Course of left ventricular ejection fraction and diagram of the therapeutic process. BTF, blood transfusion; Plt, platelet; RBC, red blood cell; SPT, steroid pulse therapy; TOC, tocilizumab; LVEF, left ventricular ejection fraction; PSL, prednisolone; ICU, intensive care unit.