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Immune checkpoint inhibitors (ICIs) have recently emerged as a promising class of anticancer therapy, demonstrating significant efficacy across various malignancies. They are currently regarded as the first-line therapy for advanced mismatch repair-deficiency colorectal cancer. However, the extensive clinical usage of ICIs has raised concerns regarding immune-related adverse events (irAEs). Herein, we describe a case of immunotherapy-related autoimmune hemolytic anemia (irAIHA) in a patient with locally advanced mismatch repair-deficiency colorectal cancer treated with toripalimab, a programmed cell death 1 (PD-1) (ICI). The patient developed grade 4 irAIHA after the first cycle of immunotherapy, which was promptly managed by discontinuing treatment and initiating high-dose prednisone. Symptoms were controlled, and hemoglobin returned to normal without resuming immunotherapy. Although hematologic irAEs such as irAIHA are relatively rare, they can be life-threatening and require immediate intervention. This case underscores the importance of vigilant monitoring, early recognition, and timely, aggressive management of irAEs during ICI therapy. In high-risk populations, including elderly patients with comorbidities, the toxicities associated with corticosteroid therapy pose additional challenges, emphasizing the need for individualized strategies that balance efficacy and safety.
Ma et al. (Mon,) studied this question.