A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer: A case report. Issue 2 (14th January 2022)

• Record Type: Journal Article
• Authors: Hamada, Kazuyuki; Yoshimura, Kiyoshi; Oshinomi, Kazuhiko; Hirasawa, Yuya; Ariizumi, Hirotsugu; Ohkuma, Ryotaro; Shida, Midori; Kubota, Yutaro; Matsui, Hiroto; Ishiguro, Tomoyuki; Sambe, Takehiko; Ishida, Hiroo; Horiike, Atsushi; Wada, Satoshi; Iwamoto, Sanju; Uchida, Naoki; Ogawa, Yoshio; Kobayashi, Shinichi; Tsunoda, Takuya
• Editors: Saranathan., Maya
• Is Part Of: Medicine. Volume 101:Issue 2(2022)
• Page Start: e28339
• Publication Date: 2022-01-14
• Subjects: anti-PD-1 antibody -- asthma -- bladder cancer -- immune-related adverse events -- pembrolizumab; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000028339
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Bladder cancer is one of the most common cancers worldwide. The anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab, which is an immune checkpoint inhibitor (ICI), has improved survival in bladder cancer. We report a case of bladder cancer that had a high antitumor effect with anti-programmed cell death PD-1 antibody pembrolizumab, an ICI, but asthma occurred an immune-related adverse event (irAE). Patient concerns: A 70-year-old female patient was diagnosed as unresectable bladder cancer who was indicated for ICI treatment. Diagnosis: After ICI administration as a treatment for bladder cancer, the patient had a grade 3 asthma attack. Cytotoxic T lymphocyte antigen 4 (CTLA-4) in CD4 + FOX3 + T cells was upregulated in the early phase before the development of asthma attacks. Moreover, T-cell immunoglobulin and mucin domain 3 (TIM-3) was upregulated in all memory T cells among CD4 + T cells. However, no change in the expression of TIM-3 was observed in any CD8 + T-cell subtype. In contrast, the proportion of CD161 - T helper 17 cell (Th17) cells increased. Interventions: The patient was treated with betamethasone, montelukast, salbutamol nebulization, and a combination of salmeterol (50 μg) and fluticasone (500 μg) (SFC). Outcomes: The patient's wheezing resolved, and her peak flow rate reached 100% of the predicted value; therefore, the patient continued treatment with SFC and montelukast and was discharged from the hospital. Conclusion: Increases in CTLA-4 and TIM-3 expression in CD4 + T cells (not CD8 + ), as well as an increase in Th17 cells, may reflect asthma-related inflammation activity. Immune-related adverse events during immune checkpoint inhibitor administration may be predictive markers of antitumor efficacy.