Yerolatsite Melina, Torounidou Nanteznta, Amylidi Anna-Lea, Kapoulitsa Fani, Kampletsas Eleftherios, Zarkavelis George, Mauri Davide
Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece.
Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece.
Case Rep Oncol. 2024 Mar 4;17(1):417-422. doi: 10.1159/000536288. eCollection 2024 Jan-Dec.
The introduction of immune checkpoint inhibitors (ICIs) has opened a new chapter in cancer treatment. Nevertheless, their use may result in immune-related adverse events (irAEs) with multifactorial determinants, complex mechanisms, and varying clinical implications. In specific cancer types, like melanoma, irAEs exhibit a complex relationship with patient outcomes.
We present a case of febrile neutropenia following ICI therapy in a patient with metastatic melanoma, underscoring the intricate clinical landscape associated with irAEs in the context of cancer immunotherapy. More specifically, a 68-year-old man was diagnosed with metastatic malignant melanoma and administered a combination of nivolumab and ipilimumab. However, after a single dose, the patient was hospitalized due to febrile neutropenia. The patient eventually recovered, but a diagnosis of myelosuppression related to prior immunotherapy led to treatment discontinuation. Subsequently, the patient transitioned to a second-line therapy.
This case contributes to our comprehension of rare yet potentially severe hematological irAEs and their influence on immunotherapy outcomes. Such insights will guide future diagnostic and therapeutic strategies in the field of immunotherapy.
免疫检查点抑制剂（ICI）的引入开启了癌症治疗的新篇章。然而，其使用可能导致免疫相关不良事件（irAE），这些不良事件具有多因素决定因素、复杂的机制以及不同的临床意义。在特定的癌症类型中，如黑色素瘤，irAE与患者预后呈现出复杂的关系。
我们报告一例转移性黑色素瘤患者在接受ICI治疗后出现发热性中性粒细胞减少的病例，强调了癌症免疫治疗背景下与irAE相关的复杂临床情况。具体而言，一名68岁男性被诊断为转移性恶性黑色素瘤，并接受了纳武利尤单抗和伊匹木单抗的联合治疗。然而，在单次给药后，患者因发热性中性粒细胞减少而住院。患者最终康复，但先前免疫治疗相关的骨髓抑制诊断导致治疗中断。随后，患者转而接受二线治疗。
该病例有助于我们理解罕见但可能严重的血液学irAE及其对免疫治疗结果的影响。这些见解将指导免疫治疗领域未来的诊断和治疗策略。
