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Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors

Ipilimumab is a monoclonal antibody that enhances the efficacy of the immune system by targeting a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which is a protein receptor that downregulates the immune system. Nivolumab is also a humanized monoclonal antibody that targets another protein re...

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Autores principales: Youssef, Alexey, Kasso, Nawara, Torloni, Antonio Sergio, Stanek, Michael, Dragovich, Tomislav, Gimbel, Mark, Mahmoud, Fade
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317083/
https://www.ncbi.nlm.nih.gov/pubmed/30671268
http://dx.doi.org/10.1155/2018/2464619
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author Youssef, Alexey
Kasso, Nawara
Torloni, Antonio Sergio
Stanek, Michael
Dragovich, Tomislav
Gimbel, Mark
Mahmoud, Fade
author_facet Youssef, Alexey
Kasso, Nawara
Torloni, Antonio Sergio
Stanek, Michael
Dragovich, Tomislav
Gimbel, Mark
Mahmoud, Fade
author_sort Youssef, Alexey
collection PubMed
description Ipilimumab is a monoclonal antibody that enhances the efficacy of the immune system by targeting a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which is a protein receptor that downregulates the immune system. Nivolumab is also a humanized monoclonal antibody that targets another protein receptor that prevents activated T cells from attacking the cancer; this receptor is called programmed cell death 1 (PD-1). The FDA approved ipilimumab combined with nivolumab as a frontline therapy for patients with metastatic melanoma or renal cell carcinoma and as a second-line therapy for patients with microsatellite instability-high (MSI-H) metastatic colon cancer. Immune-related adverse events such as autoimmune colitis, pneumonitis, hepatitis, nephritis, hypophysitis, and thyroiditis may occur during or weeks to months after therapy. We report a case of thrombotic thrombocytopenic purpura (TTP) in a patient with metastatic renal cell carcinoma following one cycle of ipilimumab and nivolumab. Only one case report of ipilimumab-induced TTP exists in the medical literature. With the wide use of immunotherapy to treat cancers, physicians need to be aware of this rare immune-related adverse event.
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spelling pubmed-63170832019-01-22 Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors Youssef, Alexey Kasso, Nawara Torloni, Antonio Sergio Stanek, Michael Dragovich, Tomislav Gimbel, Mark Mahmoud, Fade Case Rep Hematol Case Report Ipilimumab is a monoclonal antibody that enhances the efficacy of the immune system by targeting a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which is a protein receptor that downregulates the immune system. Nivolumab is also a humanized monoclonal antibody that targets another protein receptor that prevents activated T cells from attacking the cancer; this receptor is called programmed cell death 1 (PD-1). The FDA approved ipilimumab combined with nivolumab as a frontline therapy for patients with metastatic melanoma or renal cell carcinoma and as a second-line therapy for patients with microsatellite instability-high (MSI-H) metastatic colon cancer. Immune-related adverse events such as autoimmune colitis, pneumonitis, hepatitis, nephritis, hypophysitis, and thyroiditis may occur during or weeks to months after therapy. We report a case of thrombotic thrombocytopenic purpura (TTP) in a patient with metastatic renal cell carcinoma following one cycle of ipilimumab and nivolumab. Only one case report of ipilimumab-induced TTP exists in the medical literature. With the wide use of immunotherapy to treat cancers, physicians need to be aware of this rare immune-related adverse event. Hindawi 2018-12-20 /pmc/articles/PMC6317083/ /pubmed/30671268 http://dx.doi.org/10.1155/2018/2464619 Text en Copyright © 2018 Alexey Youssef et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Youssef, Alexey
Kasso, Nawara
Torloni, Antonio Sergio
Stanek, Michael
Dragovich, Tomislav
Gimbel, Mark
Mahmoud, Fade
Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title_full Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title_fullStr Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title_full_unstemmed Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title_short Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
title_sort thrombotic thrombocytopenic purpura due to checkpoint inhibitors
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317083/
https://www.ncbi.nlm.nih.gov/pubmed/30671268
http://dx.doi.org/10.1155/2018/2464619
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