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Raphael Brandao

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-19 - Thromboembolic Events Related to Immunotherapy in a NSCLC Patient: A Case Report. (ID 14099)

      12:00 - 13:30  |  Author(s): Raphael Brandao

      • Abstract


      Despite the significant clinical benefits, checkpoint inhibition is associated with a unique spectrum of immune-related adverse events. It is sometimes difficult to distinguish a rare adverse effect from a cancer progression, so such effects should be reported to be diagnosed in clinical practice.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 56-year old male patient, former smoker, was diagnosed with adenocarcinoma of lung with bone metastasis. He did not have EGFR mutation or ALK translocation, but a PD-L1 expression of 80%. The patient started first line treatment with Pembrolizumab in January 2018, and it is side effects were followed prospectively and reported.

      4c3880bb027f159e801041b1021e88e8 Result

      After second cycle he developed a grade 2 colitis, which was treated with antibiotic and corticosteroid. After the third cycle he was admitted in the hospital with worsening of dyspnea and acute confusional state. The CT scan showed focus of pneumonitis adjacent to lung lesion and signs of acute pulmonary thromboembolism, splenic and renal infarction and bilateral deep vein thrombosis. His brain MRI revealed multiple signal changes involving the juxtacortical and periventricular white matter, suggestive of an embolic event. His physical exam showed multiple petechial lesions in both arms and legs, neurological exam was consistent with left homonymous hemianopsia, left hemineglect and mild left appendicular ataxia. Cardioembolic and atheroembolic causes were discarded. His cerebrospinal fluid was negative for malignant cells. Because of the suspicion of pneumonitis and vasculitis, he received metilprednisolone 2 mg/kg and enoxaparin, with progressive improvement of the symptoms. After 10 days, he received hospital discharge and Pembrolizumab was permanently discontinued.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our case demonstrated that the PD-1 blockade has potential life threatening adverse events, with the necessity of suspension. To the best of our knowledge, that is the first case of thromboembolic events related to immunotherapy in a patient with no previous history of thrombophilia or autoimmune disease.