Aprepitant for refractory nivolumab-induced pruritus. (July 2017)

• Record Type: Journal Article
• Authors: Ito, Jiro; Fujimoto, Daichi; Nakamura, Ayaka; Nagano, Tohru; Uehara, Keiichiro; Imai, Yukihiro; Tomii, Keisuke
• Is Part Of: Lung cancer. Volume 109(2017)
• Page Start: 58
• Page End: 61
• Publication Date: 2017-07
• Subjects: ICIs immune checkpoint inhibitors -- irAEs immune-related adverse events -- NK-1R neurokinin-1 receptor -- NSCLC non-small-cell lung cancer -- SJS Stevens-Johnson syndrome; immune checkpoint inhibitors -- immune-related adverse events -- nivolumab -- Stevens-Johnson syndrome -- pruritus -- aprepitant; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2017.04.020
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: A NSCLC patient treated with nivolumab developed refractory pruritus after SJS. We used aprepitant for refractory pruritus, resulting in complete improvement. Severe skin-related irAEs from nivolumab use must be recognized and managed. Aprepitant might be a useful option for refractory pruritus caused by ICIs. Abstract: Although substantial progress has been made in the treatment of non-small-cell lung cancer (NSCLC) patients with immune checkpoint inhibitors (ICIs), severe immune-related adverse events (irAEs) sometimes occur. Here, we report a case of severe refractory pruritus after Stevens-Johnson syndrome (SJS) in a patient with NSCLC treated with nivolumab. The patient was a 76-year-old Japanese woman with advanced NSCLC treated with nivolumab. After the second dose, she experienced severe rash with mucous involvement. We diagnosed SJS and started 50 mg of oral prednisolone (1 mg/kg). The rash completely resolved after prednisolone was started, but we could not manage the severe pruritus with emollients, antihistamines, and steroids. Finally, we administered aprepitant, an oral neurokinin-1 receptor antagonist, for her refractory pruritus. Her symptoms improved within 5 days. Severe refractory pruritus can arise from ICIs, and aprepitant may be a useful treatment.