Afghan Maaz Khan, Lutfi Areeb, Qadri Fatima, Khan Sahrish, Javaid Sana, Currie Brian Michael, Rocca Juan Pablo, Samstein Benjamin, Hissong Erika, Kasi Pashtoon Murtaza
Department of Hematology and Oncology, Weill Cornell Medicine, New York, NY, USA.
Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY, USA.
Case Rep Oncol. 2024 Oct 18;17(1):1183-1193. doi: 10.1159/000541550. eCollection 2024 Jan-Dec.
Immune thrombocytopenia (ITP) secondary to durvalumab, a programmed cell death ligand 1 inhibitor, is a rare but clinically significant immune-related adverse event. Herein, we present 2 patients with cholangiocarcinoma who developed ITP immediately post-yttrium-90 radioembolization (Y90-RE) while on durvalumab-based systemic therapy. We hypothesize that given the timing, the immunotherapy and the radioembolization combination led to this event. It is not uncommon given the approval of immunotherapy and its role in locoregional therapies, that patients are treated with a combination of systemic immunotherapy and radioembolization or other forms of radiation, thus signifying the importance of potential complications.
Two patients, a 67-year-old female and a 60-year-old man, with biopsy-proven advanced unresectable cholangiocarcinoma, received a combination of systemic therapy with durvalumab, gemcitabine, and cisplatin and subsequently Y90-RE. Both patients developed ITP following in the immediate post-Y90-RE period. All other causes of ITP were comprehensively ruled out and treatment for ITP was initiated in the form of high-dose steroid and intravenous immunoglobulins. Durvalumab was discontinued, and only gemcitabine/cisplatin-based chemotherapy was continued thereafter. Due to recurrence, one of the patients required longer courses of steroids as well as thrombopoietin receptor agonists.
Immunotherapy in the form of durvalumab and now pembrolizumab alongside chemotherapy is an approved first-line standard of care. Furthermore, it is not uncommon for patients to receive Y90-RE to improve patient outcomes. This report highlights the development of ITP in 2 patients who received durvalumab alongside Y90-RE. Awareness of this as a potential immune-mediated event is important to allow for close monitoring of platelet counts and for early intervention/management when this occurs.
度伐利尤单抗（一种程序性细胞死亡配体1抑制剂）继发的免疫性血小板减少症（ITP）是一种罕见但具有临床意义的免疫相关不良事件。在此，我们报告2例胆管癌患者，他们在接受基于度伐利尤单抗的全身治疗期间，于钇-90放射性栓塞（Y90-RE）后立即发生了ITP。我们推测，鉴于发生时间，免疫治疗与放射性栓塞的联合导致了这一事件。鉴于免疫治疗的获批及其在局部区域治疗中的作用，患者接受全身免疫治疗与放射性栓塞或其他形式放疗的联合治疗并不罕见，因此这凸显了潜在并发症的重要性。
两名患者，一名67岁女性和一名60岁男性，经活检证实为晚期不可切除胆管癌，接受了度伐利尤单抗、吉西他滨和顺铂的全身治疗联合方案，随后接受了Y90-RE。两名患者均在Y90-RE后立即发生了ITP。ITP的所有其他病因均被全面排除，并以大剂量类固醇和静脉注射免疫球蛋白的形式开始了ITP治疗。度伐利尤单抗停药，此后仅继续基于吉西他滨/顺铂的化疗。由于复发原因，其中一名患者需要更长疗程的类固醇以及血小板生成素受体激动剂。
度伐利尤单抗以及现在的帕博利珠单抗与化疗联合的免疫治疗是获批的一线标准治疗方案。此外，患者接受Y90-RE以改善治疗效果并不罕见。本报告强调了2例接受度伐利尤单抗联合Y90-RE治疗的患者发生ITP的情况。认识到这是一种潜在的免疫介导事件，对于密切监测血小板计数以及在发生这种情况时进行早期干预/管理非常重要。
