Immune checkpoint inhibitors (ICIs) are emerging agents used for the treatment of various malignant
tumors. As ICIs are generally used for unresectable malignant
tumors, there have been only a few reports of patients who underwent surgery after receiving these drugs. Therefore, it remains unclear how immune-related adverse events (irAEs) affect the postoperative course. Here, we report a patient with advanced
gastric cancer who underwent laparoscopic
hepatectomy for liver
metastases after an objective response with
lenvatinib plus
pembrolizumab and developed
hypothyroidism and
hypopituitarism as irAEs in the immediate postoperative period.
CASE PRESENTATION: A 73-year-old man had undergone total
gastrectomy for pT4aN2M0
gastric cancer followed by
adjuvant chemotherapy with S-1 and
docetaxel, and developed liver
metastases in segments 6 and 7. He was enrolled in phase 2 clinical trial of
lenvatinib plus
pembrolizumab. He continuously achieved a partial response with the study treatment, and the liver
metastases were decreased in size on imaging. The
tumors were judged to be resectable and the patient underwent laparoscopic partial
hepatectomy for segments 6 and 7. From the 1st postoperative day, the patient continuously presented with
fever and general
fatigue, and his fasting
blood glucose level remained slightly lower than that before the surgery. On the 4th postoperative day, laboratory examination revealed
hypothyroidism and
hypopituitarism, which were suspected to be irAE caused by
lenvatinib plus
pembrolizumab after surgery. He received
hydrocortisone first, followed by
levothyroxine after
adrenal insufficiency was recovered. Subsequently, his
fever, general
fatigue, and any abnormality regarding fasting
blood glucose level resolved, and he was discharged on the 12th postoperative day. After discharge, his laboratory data for thyroid and pituitary function remained stable while receiving
hydrocortisone and
levothyroxine without recurrence of
gastric cancer.
CONCLUSION: