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Multiple toxicities: case report. A 66-year-old African–American woman developed mild diarrhoea, joint stiffness, nausea, fatigue and hyperprogressive disease during treatment with pembrolizumab, and diverticulitis during treatment with carboplatin and pemetrexed for lung adenocarcinoma [routes not stated; not all outcomes stated] The woman with history of diabetes mellitus type 2, smoking (25 packs a year) and essential thrombocytosis presented with right supraclavicular lymphadenopathy in 2016. She also had a history of papillary thyroid carcinoma, which was treated with total thyroidectomy and radioactive iodine ablation therapy. She was diagnosed with stage IIIB lung adenocarcinoma. Therefore, she was treated with unspecified chemoradiation followed by adjuvant chemotherapy including carboplatin and paclitaxel. Subsequently, she achieved complete response and remained disease free for 13 months. In 2018, a CT scan revealed subcarinal and hilar lymphadenopathy. After several investigations, she was diagnosed with recurrent stage IVB TxN3M1c lung adenocarcinoma with likely metastasis in brain. She underwent stereotactic radiosurgery of brain. Subsequently, she started receiving pembrolizumab 200mg every 3 weeks. She developed minor side effects including joint stiffness, mild diarrhea after 1st cycle and fatigue and nausea after 2nd cycle. After 2 weeks. She was admitted due to shortness of breath. ECG and chest CT scan revealed a large right pleural effusion with pericardial effusion. The effusions were drained through pericardiocentesis and thoracentesis. The cytology revealed malignancy, associated with poorly differentiated carcinoma. Foundation Medicine and PD-L1 (22C3) testing of pericardial fluid revealed a negative result with a tumor proportion score of 0%. She was confirmed to have hyperprogressive disease consistent with lack of response to the pembrolizumab. Therefore, the woman’s pembrolizumab therapy was switched to carboplatin (AUC 5) and pemetrexed 500 mg/m2 every 3 weeks at the end of 2018. After receiving 2 cycles of carboplatin and pemetrexed in 2019, she developed diverticulitis. She was treated with ciprofloxacin and metronidazole. The 3rd cycle was delayed by 2 weeks due to the antibiotic therapy. After completion of 3rd cycle, a CT scan revealed no evidence of disease and the treatment was stopped in favor of active surveillance. Subsequently for 20 months, she remained disease free. Fricke J, et al. Hyperprogression on immunotherapy with complete response to chemotherapy in a NSCLC patient with high PD-L1 and STK11: A case report. Medicine 99: 803520229 e22323, No. 46, 13 Nov 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000022323

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Reactions 12 Dec 2020 No. 1834