PDF(Pubmed)
Abstract：
UNASSIGNED: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.
UNASSIGNED: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a fever of 39.0 ℃ 10 days after therapy initiation. He presented 5 days later with persistent fever as well as a headache, vomiting, chills, generalized pain, fatigue, mild abdominal discomfort, and a burning rash present on his neck and face. Complete blood counts showed severe neutropenia [absolute neutrophil count (ANC) of 90 cells/µL], leukopenia [white blood cell (WBC) count 500 cells/µL], thrombocytopenia [platelet count (PC) 18,000 cells/µL], and mild anemia (hemoglobin level 12.6 gm/dL). Imaging findings showed colitis on computed tomography (CT). Atezo/bev therapy was discontinued. Treatment plan constituted of cefepime and filgrastim, a recombinant form of the naturally occurring granulocyte colony-stimulating factor (G-CSF) for febrile neutropenia, metronidazole for colitis, and intravenous methylprednisolone for immune-related toxicities. The patient fully recovered after 4 days of admission.
UNASSIGNED: In conclusion, we observed temporary severe febrile neutropenia and pancytopenia during systemic immunotherapy in a patient with unresectable HCC. Healthcare providers should consider hematological irAEs (hem-irAEs) in patients after the administration of ICIs.
UNASSIGNED: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a fever of 39.0 ℃ 10 days after therapy initiation. He presented 5 days later with persistent fever as well as a headache, vomiting, chills, generalized pain, fatigue, mild abdominal discomfort, and a burning rash present on his neck and face. Complete blood counts showed severe neutropenia [absolute neutrophil count (ANC) of 90 cells/µL], leukopenia [white blood cell (WBC) count 500 cells/µL], thrombocytopenia [platelet count (PC) 18,000 cells/µL], and mild anemia (hemoglobin level 12.6 gm/dL). Imaging findings showed colitis on computed tomography (CT). Atezo/bev therapy was discontinued. Treatment plan constituted of cefepime and filgrastim, a recombinant form of the naturally occurring granulocyte colony-stimulating factor (G-CSF) for febrile neutropenia, metronidazole for colitis, and intravenous methylprednisolone for immune-related toxicities. The patient fully recovered after 4 days of admission.
UNASSIGNED: In conclusion, we observed temporary severe febrile neutropenia and pancytopenia during systemic immunotherapy in a patient with unresectable HCC. Healthcare providers should consider hematological irAEs (hem-irAEs) in patients after the administration of ICIs.
摘要：
■免疫检查点抑制剂（ICIs），刺激T细胞功能的药物，已成为不可切除的肝细胞癌（HCC）的标准一线治疗方法。然而,它们也可能导致免疫相关的不良事件（irAE），这是罕见的，没有被广泛报道。这里,我们描述了1例严重发热性中性粒细胞减少症和全血细胞减少症患者在阿司珠单抗联合贝伐单抗(atezo/bev)治疗后出现的情况及其治疗过程.
■阿特佐/贝夫的组合是作为50岁出头的男性的一线治疗开始的，谁被诊断为不可切除的肝癌。第一个治疗周期是在门诊进行的，患者在治疗开始后10天出现39.0℃的发热。五天后，他出现持续发烧和头痛，呕吐,发冷,全身疼痛,疲劳,轻微的腹部不适,脖子和脸上有灼热的皮疹.全血细胞计数显示严重中性粒细胞减少[90个细胞/微升的中性粒细胞绝对计数(ANC)],白细胞减少症[白细胞（WBC）计数500个细胞/微升]，血小板减少症[血小板计数（PC）18,000个细胞/微升]，和轻度贫血（血红蛋白水平12.6gm/dL）。影像学发现在计算机断层扫描（CT）上显示结肠炎。Atezo/bev治疗停止。头孢吡肟和非格司亭组成的治疗方案，一种重组形式的天然存在的粒细胞集落刺激因子（G-CSF）发热中性粒细胞减少症，甲硝唑治疗结肠炎，和静脉注射甲基强的松龙治疗免疫相关毒性。患者入院4天后完全康复。
■总而言之，我们观察到1例无法切除的HCC患者在全身免疫治疗期间出现暂时性严重发热性中性粒细胞减少和全血细胞减少.医疗保健提供者应考虑ICIs给药后患者的血液学iRAE（hem-irAEs）。
■阿特佐/贝夫的组合是作为50岁出头的男性的一线治疗开始的，谁被诊断为不可切除的肝癌。第一个治疗周期是在门诊进行的，患者在治疗开始后10天出现39.0℃的发热。五天后，他出现持续发烧和头痛，呕吐,发冷,全身疼痛,疲劳,轻微的腹部不适,脖子和脸上有灼热的皮疹.全血细胞计数显示严重中性粒细胞减少[90个细胞/微升的中性粒细胞绝对计数(ANC)],白细胞减少症[白细胞（WBC）计数500个细胞/微升]，血小板减少症[血小板计数（PC）18,000个细胞/微升]，和轻度贫血（血红蛋白水平12.6gm/dL）。影像学发现在计算机断层扫描（CT）上显示结肠炎。Atezo/bev治疗停止。头孢吡肟和非格司亭组成的治疗方案，一种重组形式的天然存在的粒细胞集落刺激因子（G-CSF）发热中性粒细胞减少症，甲硝唑治疗结肠炎，和静脉注射甲基强的松龙治疗免疫相关毒性。患者入院4天后完全康复。
■总而言之，我们观察到1例无法切除的HCC患者在全身免疫治疗期间出现暂时性严重发热性中性粒细胞减少和全血细胞减少.医疗保健提供者应考虑ICIs给药后患者的血液学iRAE（hem-irAEs）。
