Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

Tumor lysis syndrome (TLS) is an oncologic emergency most frequently associated with initial treatment of hematologic malignancies and high-tumor burden solid tumors such as small-cell lung cancer (SCLC). Most often, TLS is associated with cytotoxic chemotherapy. In the treatment of SCLC, a paradigm...

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Autores principales:	Sarah Maryon Hayes, Christine Wiese, Robert Schneidewend
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	small-cell lung cancer drug therapy immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/7f3a540ff9c64291a6565598aaa03d70
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spelling	oai:doaj.org-article:7f3a540ff9c64291a6565598aaa03d702021-12-02T12:40:23ZTumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer1662-657510.1159/000519566https://doaj.org/article/7f3a540ff9c64291a6565598aaa03d702021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/519566https://doaj.org/toc/1662-6575Tumor lysis syndrome (TLS) is an oncologic emergency most frequently associated with initial treatment of hematologic malignancies and high-tumor burden solid tumors such as small-cell lung cancer (SCLC). Most often, TLS is associated with cytotoxic chemotherapy. In the treatment of SCLC, a paradigm shift has taken place in which immunotherapy is often added to chemotherapy for extensive-stage disease in the frontline setting or as monotherapy in the relapsed setting. Nivolumab is a programmed death 1 receptor blocking antibody previously FDA indicated for the treatment of metastatic SCLC with progression after platinum-based chemotherapy and at least one other line of therapy. Nivolumab, like all immune checkpoint inhibitor therapies, is associated with immune-mediated adverse reactions; however, there are few reported cases of nivolumab-induced TLS. We present a case of nivolumab-induced TLS following a single infusion. An 86-year-old female with a history of widely metastatic SCLC with metastasis to the liver, bone, and lymph nodes presented to the hospital following a fall due to weakness, dizziness, slurred speech, nausea, vomiting, and abdominal pain occurring 6 days after receiving her first nivolumab infusion. After extensive evaluation, the patient was diagnosed with TLS with hyperkalemia, acute renal failure, hyperphosphatemia, and hypocalcemia. She was treated aggressively with intravenous fluids, rasburicase, and sodium polystyrene sulfate (Kayexalate®), which resulted in rapid improvement of her electrolytes and renal function. However, despite correction of electrolytes and overall symptomatic improvement, over the course of several days, the patient’s condition rapidly deteriorated with increasing dyspnea, lethargy, confusion, and eventually death. TLS following nivolumab is exceedingly rare. This report highlights the potential risk of development of TLS with checkpoint inhibitor therapy.Sarah Maryon HayesChristine WieseRobert SchneidewendKarger Publishersarticlesmall-cell lung cancerdrug therapyimmunotherapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCase Reports in Oncology, Vol 14, Iss 3, Pp 1652-1659 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	small-cell lung cancer drug therapy immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	small-cell lung cancer drug therapy immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Sarah Maryon Hayes Christine Wiese Robert Schneidewend Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
description	Tumor lysis syndrome (TLS) is an oncologic emergency most frequently associated with initial treatment of hematologic malignancies and high-tumor burden solid tumors such as small-cell lung cancer (SCLC). Most often, TLS is associated with cytotoxic chemotherapy. In the treatment of SCLC, a paradigm shift has taken place in which immunotherapy is often added to chemotherapy for extensive-stage disease in the frontline setting or as monotherapy in the relapsed setting. Nivolumab is a programmed death 1 receptor blocking antibody previously FDA indicated for the treatment of metastatic SCLC with progression after platinum-based chemotherapy and at least one other line of therapy. Nivolumab, like all immune checkpoint inhibitor therapies, is associated with immune-mediated adverse reactions; however, there are few reported cases of nivolumab-induced TLS. We present a case of nivolumab-induced TLS following a single infusion. An 86-year-old female with a history of widely metastatic SCLC with metastasis to the liver, bone, and lymph nodes presented to the hospital following a fall due to weakness, dizziness, slurred speech, nausea, vomiting, and abdominal pain occurring 6 days after receiving her first nivolumab infusion. After extensive evaluation, the patient was diagnosed with TLS with hyperkalemia, acute renal failure, hyperphosphatemia, and hypocalcemia. She was treated aggressively with intravenous fluids, rasburicase, and sodium polystyrene sulfate (Kayexalate®), which resulted in rapid improvement of her electrolytes and renal function. However, despite correction of electrolytes and overall symptomatic improvement, over the course of several days, the patient’s condition rapidly deteriorated with increasing dyspnea, lethargy, confusion, and eventually death. TLS following nivolumab is exceedingly rare. This report highlights the potential risk of development of TLS with checkpoint inhibitor therapy.
format	article
author	Sarah Maryon Hayes Christine Wiese Robert Schneidewend
author_facet	Sarah Maryon Hayes Christine Wiese Robert Schneidewend
author_sort	Sarah Maryon Hayes
title	Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
title_short	Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
title_full	Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
title_fullStr	Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
title_full_unstemmed	Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer
title_sort	tumor lysis syndrome following a single dose of nivolumab for relapsed small-cell lung cancer
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/7f3a540ff9c64291a6565598aaa03d70
work_keys_str_mv	AT sarahmaryonhayes tumorlysissyndromefollowingasingledoseofnivolumabforrelapsedsmallcelllungcancer AT christinewiese tumorlysissyndromefollowingasingledoseofnivolumabforrelapsedsmallcelllungcancer AT robertschneidewend tumorlysissyndromefollowingasingledoseofnivolumabforrelapsedsmallcelllungcancer
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Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

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