Hisamatsu Yasushi, Morinaga Ryotaro, Watanabe Erina, Ohtani Satoshi, Shirao Kuniaki
Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita City, Oita, Japan.
Department of Respiratory Medicine, Oita Prefectural Hospital, Oita City, Oita, Japan.
Am J Case Rep. 2020 Feb 4;21:e920809. doi: 10.12659/AJCR.920809.
BACKGROUND Nivolumab is a human IgG4 monoclonal antibody against human programmed cell death 1 (PD-1). It has demonstrated efficacy against metastatic non-small cell lung cancer (NSCLC). Treatment with nivolumab is sometimes associated with immune-related adverse events (ir AEs) in patients. These specific ir AEs include pneumonitis, hypothyroidism, dermatitis, enterocolitis, hepatitis, and neuropathy. However, hematological toxicity is rare. CASE REPORT A 57-year-old man with lung adenocarcinoma, with brain and adrenal gland metastases, was therefore started on nivolumab therapy as third-line treatment. After administration of the second dose with nivolumab, grade 3 febrile neutropenia (FN) and grade 2 liver dysfunction developed in the patient. The patient was started to on intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF), and corticosteroids. Neutrophil counts and liver function gradually improved, and corticosteroids were tapered over 6 weeks. However, the patient was re-treated with G-CSF because the neutrophil counts decreased again. CONCLUSIONS Care needs to be taken with such patients because neutropenia due to treatment with nivolumab can recur, as well as other ir AEs.
背景：纳武单抗是一种针对人程序性细胞死亡蛋白1（PD-1）的人IgG4单克隆抗体。它已被证明对转移性非小细胞肺癌（NSCLC）有效。纳武单抗治疗有时会使患者出现免疫相关不良事件（irAE）。这些特定的irAE包括肺炎、甲状腺功能减退、皮炎、小肠结肠炎、肝炎和神经病变。然而，血液学毒性较为罕见。
病例报告：一名57岁的肺腺癌男性患者，伴有脑和肾上腺转移，因此开始接受纳武单抗治疗作为三线治疗。在给予第二剂纳武单抗后，患者出现了3级发热性中性粒细胞减少症（FN）和2级肝功能障碍。患者开始接受静脉抗生素、粒细胞集落刺激因子（G-CSF）和皮质类固醇治疗。中性粒细胞计数和肝功能逐渐改善，皮质类固醇在6周内逐渐减量。然而，由于中性粒细胞计数再次下降，患者再次接受了G-CSF治疗。
结论：对于此类患者需要谨慎，因为纳武单抗治疗导致的中性粒细胞减少症可能会复发，其他irAE也可能复发。
