Rare case of life-threatening thrombocytopenia occurring after radiotherapy in a patient treated with immune checkpoint inhibitor.

Abstract

Immune checkpoint inhibitors (ICIs) improve significantly outcome of patients with advanced renal cancer. Although immune-related adverse events involve frequently skin, digestive tract, lung, liver and endocrine organs, haematological toxicities are rare. We describe the case of a patient with metastatic renal cancer who was treated with nivolumab. Eight courses of nivolumab were administered without any toxicity; brain metastases were then diagnosed and treated with stereotactic radiotherapy. As the extra-cranial disease was stable, the ninth course of nivolumab was administered 5 days after the end of radiotherapy. One week later, he presented with rectal and nasal bleeding in a context of severe thrombocytopenia (1000/mm3). High dose of steroids and intravenous immunoglobulin reversed slowly the thrombocytopenia. This case highlights the possibility of life-threatening thrombocytopenia with ICIs. Interestingly, the close time relation with radiotherapy highlights a potential interaction, warranting a close follow-up of patients in this situation.

• Authors: Aurore Hendrix, Anne-Emmanuella Yeo, Sarah Lejeune, Emmanuel Seront
• Journal: BMJ case reports (BMJ Case Rep) Vol. 13 Issue 6 (Jun 09 2020) ISSN: 1757-790X [Electronic] England
• PMID: 32522726 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Glucocorticoids
• Immune Checkpoint Inhibitors
• Immunoglobulins, Intravenous
• Nivolumab

Topics

• Brain Neoplasms (pathology, secondary, therapy)
• Carcinoma, Renal Cell (pathology, physiopathology, therapy)
• Epistaxis (diagnosis, etiology)
• Gastrointestinal Hemorrhage (diagnosis, etiology)
• Glucocorticoids (administration & dosage)
• Humans
• Immune Checkpoint Inhibitors (administration & dosage, adverse effects)
• Immunoglobulins, Intravenous (administration & dosage)
• Kidney Neoplasms (pathology, physiopathology, therapy)
• Lung Neoplasms (drug therapy, pathology, secondary)
• Male
• Middle Aged
• Neoplasm Staging
• Nephrectomy (methods)
• Nivolumab (administration & dosage, adverse effects)
• Radiosurgery (methods)
• Rectal Diseases (diagnosis, etiology)
• Thrombocytopenia (chemically induced, complications, diagnosis)
• Treatment Outcome