ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Alopecia Areata as a Side Effect of Immune Checkpoint Inhibitor Pembrolizumab in a Patient with Advanced Non-Small Cell Lung Cancer
Session Title
TP139 - TP139 THORACIC ONCOLOGY: CASE REPORTS - NON-SMALL CELL LUNG CANCER
Abstract
A4861 - Alopecia Areata as a Side Effect of Immune Checkpoint Inhibitor Pembrolizumab in a Patient with Advanced Non-Small Cell Lung Cancer
Author Block: A. Oganesyan1, L. Hayrapetyan2; 1Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia, 2BioMedical Science, Radiation Oncology, University of Bern, Bern, Switzerland.
Background: Cutaneous adverse events may develop in up to 10-35% of patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors. While most of these events are mild and are adequately managed with the administration of topical corticosteroids, a small percentage of these cases require the prescription of systemic steroids, and even fewer events prompt for the discontinuation of immunotherapy entirely. In contrast to chemotherapy, patients receiving immunotherapy develop total scalp hair loss infrequently, whereas a localized nonscarring hair loss - alopecia areata is an extremely rare manifestation. Although the pathogenesis of these lesions is poorly characterized, some studies have shown that a poorly regulated immune response may be a potential contributor to these effects. Case description: A 59-year-old male was diagnosed with advanced NSCLC with a PD-L1 expression of 35% (Stage IIIB, Grade III). His medical history includes 40 pack-years of smoking, partial lung resection (performed 23 years prior to presentation due to spontaneous pneumothorax), controlled hypertension, uncontrolled COPD, and successfully treated Graves’ disease in 2017. The patient has been receiving a systemic therapy consisting of platinum-based doubled chemotherapy and pembrolizumab since November 2019 with maintaining immunotherapy until the present. Soon after starting the combined immunochemotherapy, the patient developed total hair loss. Following the last regimen of chemotherapy, normal hair regrowth began without any specific patterns. However, after several weeks of maintenance treatment with pembrolizumab only, local hair loss started along the scalp, right eyebrow, and face (with a latency of local hair loss at around 8 months). This was accompanied by a localized rash in the occipital region. Both the rash and hair loss have not been medically managed and remain unresolved to this day. By December 2020, the patient achieved a complete metabolic response as evidenced by most recent PET-CT reports. Other side effects caused by the systemic treatment included thyroid immune reaction manifested as hyper- followed by hypothyroidism. Discussion: This case highlights a rare manifestation of pembrolizumab in a patient treated for NSCLC - alopecia areata. To our best knowledge, this is the first case of such an event. We believe that the present report will be important for clinicians as it provides a valuable addition to the list of rare manifestations of immunotherapy with PD-1 inhibitors. It also may contribute to the understanding of the potential associations between clinical response or improved outcomes and the side effects of a new type of lung cancer treatment.
Author Block: A. Oganesyan1, L. Hayrapetyan2; 1Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia, 2BioMedical Science, Radiation Oncology, University of Bern, Bern, Switzerland.
Background: Cutaneous adverse events may develop in up to 10-35% of patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors. While most of these events are mild and are adequately managed with the administration of topical corticosteroids, a small percentage of these cases require the prescription of systemic steroids, and even fewer events prompt for the discontinuation of immunotherapy entirely. In contrast to chemotherapy, patients receiving immunotherapy develop total scalp hair loss infrequently, whereas a localized nonscarring hair loss - alopecia areata is an extremely rare manifestation. Although the pathogenesis of these lesions is poorly characterized, some studies have shown that a poorly regulated immune response may be a potential contributor to these effects. Case description: A 59-year-old male was diagnosed with advanced NSCLC with a PD-L1 expression of 35% (Stage IIIB, Grade III). His medical history includes 40 pack-years of smoking, partial lung resection (performed 23 years prior to presentation due to spontaneous pneumothorax), controlled hypertension, uncontrolled COPD, and successfully treated Graves’ disease in 2017. The patient has been receiving a systemic therapy consisting of platinum-based doubled chemotherapy and pembrolizumab since November 2019 with maintaining immunotherapy until the present. Soon after starting the combined immunochemotherapy, the patient developed total hair loss. Following the last regimen of chemotherapy, normal hair regrowth began without any specific patterns. However, after several weeks of maintenance treatment with pembrolizumab only, local hair loss started along the scalp, right eyebrow, and face (with a latency of local hair loss at around 8 months). This was accompanied by a localized rash in the occipital region. Both the rash and hair loss have not been medically managed and remain unresolved to this day. By December 2020, the patient achieved a complete metabolic response as evidenced by most recent PET-CT reports. Other side effects caused by the systemic treatment included thyroid immune reaction manifested as hyper- followed by hypothyroidism. Discussion: This case highlights a rare manifestation of pembrolizumab in a patient treated for NSCLC - alopecia areata. To our best knowledge, this is the first case of such an event. We believe that the present report will be important for clinicians as it provides a valuable addition to the list of rare manifestations of immunotherapy with PD-1 inhibitors. It also may contribute to the understanding of the potential associations between clinical response or improved outcomes and the side effects of a new type of lung cancer treatment.
