Narukawa Tsukasa, Hongo Fumiya, Fujihara Atsuko, Ueno Akihisa, Matsugasumi Toru, Ukimura Osamu
Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Case Rep Oncol. 2020 Mar 24;13(1):249-254. doi: 10.1159/000506196. eCollection 2020 Jan-Apr.
Nivolumab, a programmed death-1 checkpoint inhibitor, is worldwide available for metastatic renal cell carcinoma (mRCC). Limited data exist on the response to vascular endothelial growth factor receptor-tyrosine kinase inhibitor (TKI) therapy after administration of nivolu-mab. In this case study, we report on a patient with tumor lysis syndrome (TLS), which was induced by pazopanib after the administration of nivolumab. A 69-year-old woman with a primary diagnosis of mRCC received pazopanib as a fourth-line therapy, after sunitinib, axitinib, and nivolumab as first-, second-, and third-line therapies, respectively. Two weeks after the administration of pazopanib, she presented to the emergency room of our institution, complaining of fatigue associated with nausea and diarrhea. Her laboratory results showed hyperphosphatemia, hyperuricemia, hypocalcemia, and possible acute kidney injury; the results were consistent with TLS. Our case report highlights TLS as a potential reaction to pazopanib following nivolumab; and we consider careful observation is necessary when administering TKI after immune checkpoint inhibitors.
纳武单抗是一种程序性死亡-1检查点抑制剂，在全球范围内可用于治疗转移性肾细胞癌（mRCC）。关于纳武单抗给药后对血管内皮生长因子受体-酪氨酸激酶抑制剂（TKI）治疗的反应，现有数据有限。在本病例研究中，我们报告了1例在使用纳武单抗后因帕唑帕尼诱发肿瘤溶解综合征（TLS）的患者。一名69岁的女性，最初诊断为mRCC，分别接受舒尼替尼、阿昔替尼和纳武单抗作为一线、二线和三线治疗后，接受帕唑帕尼作为四线治疗。帕唑帕尼给药两周后，她到我们机构的急诊室就诊，主诉疲劳并伴有恶心和腹泻。她的实验室检查结果显示高磷血症、高尿酸血症、低钙血症以及可能的急性肾损伤；结果与TLS相符。我们的病例报告强调TLS是纳武单抗治疗后使用帕唑帕尼可能出现的反应；并且我们认为在免疫检查点抑制剂之后给予TKI时需要仔细观察。
