TY - JOUR
T1 - Severe febrile neutropenia and pancytopenia in a patient with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab
T2 - a case report
AU - Chamseddine, Shadi
AU - LaPelusa, Michael
AU - Carter, Kristen
AU - Nguyen, Van
AU - Mohamed, Yehia I.
AU - Sakr, Yara
AU - Rojas-Hernandez, Cristhiam M.
AU - Hatia, Rikita I.
AU - Hassan, Manal
AU - Goss, John A.
AU - Elsayes, Khaled M.
AU - Rashid, Asif
AU - Sun, Ryan
AU - Cao, Hop Sanderson Tran
AU - Amin, Hesham M.
AU - Kaseb, Ahmed O.
N1 - Publisher Copyright:
© 2024 AME Publishing Company. All rights reserved.
PY - 2024/6
Y1 - 2024/6
N2 - Background: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course. Case Description: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a fever of 39.0 °C 10 days after therapy initiation. He presented 5 days later with persistent fever as well as a headache, vomiting, chills, generalized pain, fatigue, mild abdominal discomfort, and a burning rash present on his neck and face. Complete blood counts showed severe neutropenia [absolute neutrophil count (ANC) of 90 cells/μL], leukopenia [white blood cell (WBC) count 500 cells/μL], thrombocytopenia [platelet count (PC) 18,000 cells/μL], and mild anemia (hemoglobin level 12.6 gm/dL). Imaging findings showed colitis on computed tomography (CT). Atezo/bev therapy was discontinued. Treatment plan constituted of cefepime and filgrastim, a recombinant form of the naturally occurring granulocyte colony-stimulating factor (G-CSF) for febrile neutropenia, metronidazole for colitis, and intravenous methylprednisolone for immune-related toxicities. The patient fully recovered after 4 days of admission. Conclusions: In conclusion, we observed temporary severe febrile neutropenia and pancytopenia during systemic immunotherapy in a patient with unresectable HCC. Healthcare providers should consider hematological irAEs (hem-irAEs) in patients after the administration of ICIs.
AB - Background: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course. Case Description: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a fever of 39.0 °C 10 days after therapy initiation. He presented 5 days later with persistent fever as well as a headache, vomiting, chills, generalized pain, fatigue, mild abdominal discomfort, and a burning rash present on his neck and face. Complete blood counts showed severe neutropenia [absolute neutrophil count (ANC) of 90 cells/μL], leukopenia [white blood cell (WBC) count 500 cells/μL], thrombocytopenia [platelet count (PC) 18,000 cells/μL], and mild anemia (hemoglobin level 12.6 gm/dL). Imaging findings showed colitis on computed tomography (CT). Atezo/bev therapy was discontinued. Treatment plan constituted of cefepime and filgrastim, a recombinant form of the naturally occurring granulocyte colony-stimulating factor (G-CSF) for febrile neutropenia, metronidazole for colitis, and intravenous methylprednisolone for immune-related toxicities. The patient fully recovered after 4 days of admission. Conclusions: In conclusion, we observed temporary severe febrile neutropenia and pancytopenia during systemic immunotherapy in a patient with unresectable HCC. Healthcare providers should consider hematological irAEs (hem-irAEs) in patients after the administration of ICIs.
KW - atezolizumab
KW - bevacizumab
KW - case report
KW - hematological immune-related adverse events (hem-irAEs)
KW - Hepatocellular carcinoma (HCC)
UR - http://www.scopus.com/inward/record.url?scp=85197644284&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85197644284&partnerID=8YFLogxK
U2 - 10.21037/jgo-24-290
DO - 10.21037/jgo-24-290
M3 - Article
C2 - 38989410
AN - SCOPUS:85197644284
SN - 2078-6891
VL - 15
SP - 1324
EP - 1330
JO - Journal of Gastrointestinal Oncology
JF - Journal of Gastrointestinal Oncology
IS - 3
ER -