ecancermedicalscience

Case Report

Re-challenge of immune checkpoint inhibitor pembrolizumab with concurrent tocilizumab after prior grade 3 pneumonitis

8 Dec 2023
Chitrakshi Nagpal, Sameer Rastogi, Shamim A Shamim, Sneha Prakash

Immune checkpoint inhibitors (ICIs) are associated with specific immune-related adverse events (irAEs) which are unique compared to cytotoxic chemotherapy. For life-threatening adverse events including grade 3 or more, permanent discontinuation of the ICIs is recommended, albeit without much robust evidence. Safe re-challenge of ICIs with concurrent immunosuppression has been reported with irAEs like gastrointestinal toxicity and arthritis. Here we present a case of a lady with undifferentiated pleomorphic sarcoma with programmed death ligand1 expression, who showed a complete response to pembrolizumab used as third-line therapy. However, it had to be stopped after 22 doses when the patient developed grade 3 pneumonitis. In view of progression off pembrolizumab, and lack of other effective alternatives, pembrolizumab was re-challenged with concurrent interleukin-6 (IL-6) blockade using tocilizumab. This was based on preliminary evidence on the role of IL-6 in mediating the irAEs, especially pneumonitis. The patient re-attained a complete response with pembrolizumab. There was no recurrence of the pneumonitis after rechallenging, and there was partial radiographic resolution of the ICI-interstitial lung disease after the combination therapy.

Related Articles

Gustavo Hipólito Diaz Infantes, Edgar Fermín Yan Quiroz, Luis Fernando Meza Montoya, José Richard Tenazoa Villalobos
Oluwaseyi K Idowu, Adewumi O Alabi, Ibijoke A Idowu, Opeyemi I Olusunmade, Bright A Igbinoba, Abdulwahab Ajani, Mohammed Y M Habeebu, Jane U Igwilo, Kolawole O Aramide, Eyitayo O Alabi, Fatimah B Abdulkareem, Samuel U Eyesan, Suleiman O Giwa
Omolara Aminat Fatiregun, Yetunde Kuyinu, Adewunmi Alabi, Anthonia Sowunmi, Okunuga Ndidi, Popoola O Abiodun, Temitope Olatunji-Agunbiade, Oyekan Ademola, Nnodimele Onuigbo Atulomah, Awotayo Olajumoke
Francis Okongo, Catherine Amuge, Alfred Jatho, Nixon Niyonzima, David Martin Ogwang, Jackson Orem
Carlos A. Castaneda, Miluska Castillo, Joselyn Sanchez, Luis Bernabe, Katherin Tello, Nancy Suarez, Raul Alatrista, Ximena Quiroz-Gil, Alexandra Granda-Oblitas, Javier Enciso, Nathaly Enciso, Henry L Gomez