Cargando…

Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer

Immune-related adverse events (IRAEs) are a common yet problematic phenomenon in patients who are treated with immune checkpoint inhibitors (ICIs). Current research efforts have explored the exact pathophysiology of IRAEs in the clinical setting. However, a rare subset of IRAEs that is less highligh...

Descripción completa

Detalles Bibliográficos
Autores principales: Baroz, Angel R, Mambetsariev, Isa, Fricke, Jeremy, Pharaon, Rebecca, Tan, TingTing, Kidambi, Trilokesh, Sandhu, Karamjeet S, Koczywas, Marianna, Salgia, Ravi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349225/
https://www.ncbi.nlm.nih.gov/pubmed/34377604
http://dx.doi.org/10.7759/cureus.16266
_version_ 1783735522306293760
author Baroz, Angel R
Mambetsariev, Isa
Fricke, Jeremy
Pharaon, Rebecca
Tan, TingTing
Kidambi, Trilokesh
Sandhu, Karamjeet S
Koczywas, Marianna
Salgia, Ravi
author_facet Baroz, Angel R
Mambetsariev, Isa
Fricke, Jeremy
Pharaon, Rebecca
Tan, TingTing
Kidambi, Trilokesh
Sandhu, Karamjeet S
Koczywas, Marianna
Salgia, Ravi
author_sort Baroz, Angel R
collection PubMed
description Immune-related adverse events (IRAEs) are a common yet problematic phenomenon in patients who are treated with immune checkpoint inhibitors (ICIs). Current research efforts have explored the exact pathophysiology of IRAEs in the clinical setting. However, a rare subset of IRAEs that is less highlighted and may cause detrimental effects are hematological IRAEs (heme-IRAEs). Of note, immune-induced eosinophilia itself is a heme-IRAE that is worthy of further investigation. In this report, we present two cases of advanced staged non-small cell lung cancer (NSCLC) treated with single-agent pembrolizumab, and who subsequently sustained markedly elevated eosinophil counts (EEC) on laboratory findings. The two patients were Caucasian and both were diagnosed with NSCLC, although with differing histologies: a 76-year-old male with adenocarcinoma and a 66-year-old female with squamous cell carcinoma. Programmed death-ligand 1 (PD-L1) expression was detected via immunohistochemistry (IHC) and molecular tumor profiling did not show any actionable oncogenic mutations. Both patients were treatment-naïve and received pembrolizumab as first-line systemic therapy. The male patient, a former heavy smoker, underwent 18 months of pembrolizumab treatment before high eosinophil counts and was diagnosed with immunotherapy-related apoptotic colopathy after colonoscopy. Following pembrolizumab discontinuation, he remains under surveillance with good disease control and does not show any ongoing symptoms. The female patient, a never-smoker, underwent 15 cycles of pembrolizumab before the discontinuation of the treatment after consistently high levels of eosinophil counts. Both patients were treated with systemic corticosteroids after the discontinuation of immunotherapy, and their eosinophil levels returned to normal values. However, the female patient declined any further therapy and expired 24 months after the discontinuation of immunotherapy. Immune-induced eosinophilia is a rare event and reported in only 2.9% of NSCLC cases. Outcomes in the two patients differed, indicating that further research related to eosinophilia and its causes in the context of varying histologies and clinical profiles of patients is warranted.
format Online
Article
Text
id pubmed-8349225
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-83492252021-08-09 Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer Baroz, Angel R Mambetsariev, Isa Fricke, Jeremy Pharaon, Rebecca Tan, TingTing Kidambi, Trilokesh Sandhu, Karamjeet S Koczywas, Marianna Salgia, Ravi Cureus Oncology Immune-related adverse events (IRAEs) are a common yet problematic phenomenon in patients who are treated with immune checkpoint inhibitors (ICIs). Current research efforts have explored the exact pathophysiology of IRAEs in the clinical setting. However, a rare subset of IRAEs that is less highlighted and may cause detrimental effects are hematological IRAEs (heme-IRAEs). Of note, immune-induced eosinophilia itself is a heme-IRAE that is worthy of further investigation. In this report, we present two cases of advanced staged non-small cell lung cancer (NSCLC) treated with single-agent pembrolizumab, and who subsequently sustained markedly elevated eosinophil counts (EEC) on laboratory findings. The two patients were Caucasian and both were diagnosed with NSCLC, although with differing histologies: a 76-year-old male with adenocarcinoma and a 66-year-old female with squamous cell carcinoma. Programmed death-ligand 1 (PD-L1) expression was detected via immunohistochemistry (IHC) and molecular tumor profiling did not show any actionable oncogenic mutations. Both patients were treatment-naïve and received pembrolizumab as first-line systemic therapy. The male patient, a former heavy smoker, underwent 18 months of pembrolizumab treatment before high eosinophil counts and was diagnosed with immunotherapy-related apoptotic colopathy after colonoscopy. Following pembrolizumab discontinuation, he remains under surveillance with good disease control and does not show any ongoing symptoms. The female patient, a never-smoker, underwent 15 cycles of pembrolizumab before the discontinuation of the treatment after consistently high levels of eosinophil counts. Both patients were treated with systemic corticosteroids after the discontinuation of immunotherapy, and their eosinophil levels returned to normal values. However, the female patient declined any further therapy and expired 24 months after the discontinuation of immunotherapy. Immune-induced eosinophilia is a rare event and reported in only 2.9% of NSCLC cases. Outcomes in the two patients differed, indicating that further research related to eosinophilia and its causes in the context of varying histologies and clinical profiles of patients is warranted. Cureus 2021-07-08 /pmc/articles/PMC8349225/ /pubmed/34377604 http://dx.doi.org/10.7759/cureus.16266 Text en Copyright © 2021, Baroz et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Oncology
Baroz, Angel R
Mambetsariev, Isa
Fricke, Jeremy
Pharaon, Rebecca
Tan, TingTing
Kidambi, Trilokesh
Sandhu, Karamjeet S
Koczywas, Marianna
Salgia, Ravi
Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title_full Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title_fullStr Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title_full_unstemmed Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title_short Elevated Eosinophil Count Following Pembrolizumab Treatment for Non-Small Cell Lung Cancer
title_sort elevated eosinophil count following pembrolizumab treatment for non-small cell lung cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349225/
https://www.ncbi.nlm.nih.gov/pubmed/34377604
http://dx.doi.org/10.7759/cureus.16266
work_keys_str_mv AT barozangelr elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT mambetsarievisa elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT frickejeremy elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT pharaonrebecca elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT tantingting elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT kidambitrilokesh elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT sandhukaramjeets elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT koczywasmarianna elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer
AT salgiaravi elevatedeosinophilcountfollowingpembrolizumabtreatmentfornonsmallcelllungcancer