Evan O Cordrey1 and Jue Wang2*
1Department of Genitourinary Oncology, Creighton University School of Medicine, USA
2Department of Genitourinary Oncology Section, University of Arizona Cancer Center at Dignity Health, USA
Background: Immune-checkpoint blocking antibodies including anti-CTLA-4 and antiprogrammed death-1 (PD-1) and programmed death ligand-1 (PD-L1) inhibitor therapy have demonstrated marked efficacy in several advanced solid tumors. Optimal use of these agents requires prompt recognition and management of immune-mediated toxicities and other adverse events. The objective of this study was to investigate the clinical characteristics and outcomes of Tumor Lysis Syndrome (TLS), a rare but life-threatening adverse effects in solid tumor associated with the use of immune checkpoint inhibitor.
Methods: Retrospective review and pooled analysis.
Result: Six cases of TLS related to checkpoint inhibitors identified. In four case reports with adequate clinical outcome information, the median age of patients was 75 years (73-77). Male to female ratio was 3:1. All patients had extensive liver metastases. The median time from treatment to TLS was 14 days (2-33). All four patients (100%) died from TLS.
Conclusion: TLS associated with CTLA4 and checkpoint blocking immunotherapy in solid tumor can be life-threatening. We discuss potential mechanisms of PD1 blocking immunotherapy associated TLS. Prospective studies should be conducted to investigate the incidence, clinical characteristics, optimal management and outcome of these rare but life-threatening adverse events.
Tumor Lysis Syndrome (TLS); Checkpoint Inhibitors; Programmed cell death 1 protein (PD-1); programmed cell death 1 ligand 1(PD-L1); Adverse Effects (AEs); immunotherapies
Cordrey EO , Wang J. Tumor Lysis Syndrome Associated with Immune Checkpoint Blockade in Solid Tumors. Jpn J Cancer Oncol Res. 2018; 1(1): 1005.