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Various toxicities: case report A 73-year-old man developed grade-4 leukopenia, grade-2 nausea and vomiting following treatment with paclitaxel and carboplatin for pulmonary sarcomatoid carcinoma. He also developed severe allergic reactions during treatment with mesna for prevention of urinary tract toxicity. Additionally, he developed grade-2 respiratory insufficiency, loss of appetite, cough, fever, Staphylococcus aureus infection and Candida albicans infection during treatment with pembrolizumab [Keytruda] for pulmonary sarcomatoid carcinoma [not all dosages and routes stated]. The man was diagnosed with pulmonary sarcomatoid carcinoma He started receiving paclitaxel 220mg and carboplatin 380mg on day 1 for 21 day cycle on 05 June 2018, followed by radiotherapy. He also received morphine for chest pain. After chemotherapy, he experienced grade 4 leucopenia and grade 2 nausea and vomiting. Due to intolerance to chemotherapy, later, he started receiving second-line therapy with oral anlotinib 12mg on day 1-14 every three weeks from 14 June 2018. Subsequently, he developed grade 3 hypertension, grade 2 nausea/vomiting, fatigue and loss of appetite; hence, anlotinib was discontinued on 26 June 2018. At the same time, radiation treatment was also stopped. Afterwards, due to tumor progression, tumor tests showed high PD-L1 expression. He also started receiving mesna injection for the prophylaxis of urinary tract toxicity. Subsequently, he developed severe allergic reactions, including tightness, throat edema and redness, and mesna was discontinued. Thereafter, he started receiving pembrolizumab [Keytruda] 100mg on 17 July 2018. Two days later, he experienced fever and cough with sputum. Blood culture showed Staphylococcus aureus and sputum culture showed Candida albicans. He developed grade 2 respiratory insufficiency and loss of appetite, and pembrolizumab was discontinued. The man was treated with linezolid and fluconazole. After six week of treatment, he recovered. Nine months after receiving pembrolizumab, he died due to disease progression in the right adrenal gland. Chen P, et al. Significant benefits of pembrolizumab in treating refractory advanced pulmonary sarcomatoid carcinoma: A case report. World Journal of Clinical Cases 8: 803497842 2876-2884, No. 13, Jul 2020. Available from: URL: http://doi.org/10.12998/wjcc.v8.i13.2876

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Reactions 22 Aug 2020 No. 1818