Pembrolizumab
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Immune-related thrombocytopenia: case report A 79-year-old man developed immune-related thrombocytopenia during treatment with pembrolizumab for non-small cell lung cancer (NSCLC). The man, who had advanced NSCLC, was receiving pembrolizumab as second-line therapy [dosage and route not stated]. Prior to the treatment, his complete blood count (CBC) was normal. Eleven days following the start of pembrolizumab, he presented with petechiae on his upper limbs, lower limbs, and palate. CBC showed severe thrombocytopenia. Bone marrow aspiration revealed normal cellularity with increased megakaryocytes. There was no evidence of malignant invasion. Results for Serum Helicobacter pylori immunoglobulin G and antinuclear antibodies were negative while platelet-associated immunoglobulin G was positive. There were no signs of infection or autoimmune disorders. Thus, a diagnosis of pembrolizumab-induced immune-related thrombocytopenia was made. The man was initially treated with prednisolone and IV immunoglobulin for 3 days, along with platelet transfusions. The platelet count temporarily increased only slightly. Afterwards, he received IV rituximab for thrombocytopenia. Following four weekly rituximab infusion, his symptoms and thrombocytopenia improved. However, two months after the end of rituximab treatment, he again presented with petechiae on his upper and lower limbs. Repeat CBC revealed severe thrombocytopenia. He was then treated with dexamethasone and eltrombopag [eltrombopag olamine]. Immediately, his symptoms and thrombocytopenia improved. Four months later, eltrombopag treatment was stopped, because his physical findings were stable and platelet count also increased. After the end of eltrombopag treatment, there were no relapses of thrombocytopenia. However, the tumor progressed, and he was treated with paclitaxel [nab-Paclitaxel]. There was no relapse of the thrombocytopenia. Two months following the end of the eltrombopag treatment, he died of disease progression. At the time of death, there was no relapse of the immune-related thrombocytopenia. Ito M, et al. Eltrombopag olamine for refractory immune-related thrombocytopenia induced by pembrolizumab in a non-small cell lung cancer patient. Lung Cancer 146: 803499319 362-365, Aug 2020. Available from: URL: http://doi.org/10.1016/j.lungcan.2020.05.015
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Reactions 5 Sep 2020 No. 1820
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