Advanced non-small cell lung cancer patient with a complete response and allergic immune-related adverse events by combined immunotherapy, including anti-CTLA-4 and anti-PD-1 antibodies: A case report

Abstract

Immune checkpoint inhibitors (ICIs) are indispensable agents that may improve the long-term prognosis of non-small cell lung cancer. However, clinicians should always be aware that its immune-modulating mechanism of action may lead to unexpected immune-related adverse events (irAE). We report here a case of a 72-year-old man with adenocarcinoma of the lung who achieved a complete response to nivolumab plus ipilimumab plus chemotherapy but also suffered from a variety of immune-related adverse events. In this patient, Th1 immunity, which is involved in antitumor immunity, and Th2 immunity were activated, resulting in allergy-related reactions, including increased airway hyperresponsiveness and a marked increase in serum IgE levels. After starting corticosteroids, the allergic symptoms were well controlled. Remarkably, despite discontinuing ICI treatment, the patient has maintained a complete response for 27 months. Fortunately, we obtained lung and lymph node tissues from this patient after ICI administration and histologically examined the Th1 and Th2 immune status.