Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1580-1585
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1580
Tumor-related cytokine release syndrome in a treatment-naïve patient with lung adenocarcinoma: A case report
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li, Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li, Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li, Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li, Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha 410008, Hunan Province, China
Peng-Bo Deng, Juan Jiang, Cheng-Ping Hu, Li-Ming Cao, Min Li, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Author contributions: Deng PB contributed to investigation and wrote the manuscript; Hu CP contributed to funding acquisition; Cao LM and Jiang J contributed to investigation; Li M contributed to review and editing; all authors have read and approve the final manuscript.
Supported by National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases (Lung Cancer); National Key R&D Program of China, No. 2016YFC1303300; Xiangya Clinical Big Data Project of Central South University (Clinical big data project of lung cancer).
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Li, MD, PhD, Chief Doctor, Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha 410008, Hunan Province, China. limin2050@csu.edu.cn
Received: September 6, 2021
Peer-review started: September 6, 2021
First decision: December 1, 2021
Revised: December 7, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: February 16, 2022
Processing time: 157 Days and 17.5 Hours
Abstract
BACKGROUND

Cytokine release syndrome (CRS) is defined as systemic inflammation that usually occurs following chimeric antigen receptor T-cell therapy administration; however, it has not been reported in patients with untreated non-small cell lung cancer to date.

CASE SUMMARY

A 44-year-old nonsmoking woman presented to the hospital due to fever, palpitation, nausea, and cough for 1 mo and was diagnosed with stage cT3N3M0 (IIIc) adenocarcinoma of the lung. Auxiliary examinations revealed elevated cytokine [tumor necrosis factor-α, interleukin (IL)-1β, and IL-6] and inflammatory factor levels, which decreased after treatment with corticosteroids and immunoglobulin and when tumor growth was controlled following chemotherapy, radiotherapy, and antiangiogenesis therapy. However, tumor recurrence was observed. After administration of nivolumab as third-line treatment, the patient’s condition was transiently controlled; however, CRS-like symptoms suddenly emerged, which led to a resurgence of cytokines and inflammatory factors and rapid death.

CONCLUSION

CRS can develop in treatment-naïve lung cancer patients. Patients with tumor-related CRS may be at risk of CRS recurrence, aggravation, and onset of immune checkpoint inhibitor-related adverse events.

Keywords: Cytokine release syndrome; Non-small cell lung cancer; Immune checkpoint inhibitors; Nivolumab; Tumor necrosis factor α; Interleukin-1β; Interleukin-6; Case report

Core Tip: Cytokine release syndrome (CRS) is defined as systemic inflammation that usually occurs after chimeric antigen receptor T-cell therapy is administered. But the case we report suggests CRS can develop in treatment-naïve lung cancer patient. Patients with tumor-related CRS may be at risk of CRS recurrence, aggravation, and onset of immune checkpoint inhibitor (ICI)-related adverse events when ICIs are administered. Therefore, it is necessary to carefully evaluate whether the patient has CRS prior to the initiation of ICI treatment.