Key result
Dual checkpoint inhibition linked to severe small vessel vasculitis and dry gangrene.
Why the study?
Skin-related toxicities are the most commonly reported treatment-related adverse events from combined PD-1 and CTLA-4 blockade therapy in malignant pleural mesothelioma, but detailed reports of severe complications like small vessel vasculitis are limited.
Does combined PD-1 and CTLA-4 blockade therapy cause small vessel vasculitis and dry gangrene in a patient with malignant pleural mesothelioma?
Case Report (n=1)
Does combined PD-1 and CTLA-4 blockade therapy cause small vessel vasculitis and dry gangrene in a patient with malignant pleural mesothelioma?
Combined CTLA-4 and PD-1 blockade can cause severe small vessel vasculitis leading to digital ischaemia and gangrene, requiring early detection and multispecialty management.
BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour with an overall poor prognosis. In October 2020, first line treatment with the PD-1 antagonist nivolumab and the CTLA-4 antagonist ipilimumab for unresectable disease was FDA approved-the first approved treatment regime since 2004. Interim analyses from the phase 3 CHECKMATE-743 study shows improvements in overall survival. Skin-related toxicities are the most commonly reported any-grade treatment-related adverse event from combined nivolumab and ipilimumab therapy. CASE PRESENTATION: Here we report a case of a 35-year-old white male who developed digital ischaemia secondary to small vessel vasculitis after receiving PD-1 and CTLA-4 blockade therapy for MPM. His progressive ischaemia became gangrenous, and he required multi-speciality input and treatment with prednisolone, prostacyclin, mycophenolate mofetil and hydroxychloroquine. CONCLUSIONS: Our case highlights the importance of early detection, intervention, and a multispecialty approach to managing such complications in order to minimise the associated morbidity and mortality.
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Kefas et al. (2022) conducted a case report in Malignant pleural mesothelioma (n=1). Combined CTLA-4 and PD-1 blockade (ipilimumab and pembrolizumab) was evaluated on Development of small vessel vasculitis and dry gangrene. Combined ipilimumab and pembrolizumab therapy in a 35-year-old male with malignant pleural mesothelioma resulted in the development of severe small vessel vasculitis and dry gangrene.
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