Pembrolizumab-induced acute thrombosis: A case report

Rationale:Acute thrombosis has not been reported in the literature so far in lung cancer patients as an immune-related adverse event (irAE) associated with PD-1 pathway inhibitors.Patients concerns:Here, we for the first time present two NSCLC (non-small cell lung cancer) patients suffering from acute thrombosis as a pembrolizumab-induced irAE. Immediate treatment with continuous heparin infusion improved their symptoms and enabled them to continue pembrolizumab administration.Methods:Ethical approval was given by the ethics committee of Osaka International Cancer Institute and the informed consents were given by the patients.Diagnosis:Serum D-dimer level testing, venous ultrasonography, enhanced computed tomography (CT).Interventions:Continuous heparin infusion, direct oral anticoagulants (DOAC).Outcomes:Immediate continuous heparin infusion improved their symptoms and continuing pembrolizumab with direct oral anticoagulant successfully induced tumor shrinkage.Lessons:Reinvigoration of exhausted T cells by pembrolizumab induced systemic inflammation possibly resulting in development of thrombosis. Although acute thrombosis is a rare irAE, it may lead to cessation of treatment and can be lethal.