Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4110
Peer-review started: January 31, 2021
First decision: March 15, 2021
Revised: March 16, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 6, 2021
Atezolizumab is a programmed death ligand 1 (PD-L1) inhibitor, and its combi
A 75-year-old man was diagnosed with HCC recurrence after hepatectomy. He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1 (PD-1) inhibitor. The patient showed a sudden onset of dizziness, numbness, and lack of consciousness with severe hypotension during atezolizumab infusion. The treatment was stopped immediately. The patient’s symptoms resolved after 5 mg dexamethasone was administered. Because of repeated hypersensitivity reactions to ICIs, treatment was changed to oral targeted regorafenib therapy.
Further research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.
Core Tip: Treatment with immune checkpoint inhibitors (ICIs) can lead to hypersensitivity reactions; however, anaphylactic shock is rare. We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review. Patients may be allergic to drugs targeting both programmed death-1 (PD-1) and programmed death ligand 1 (PD-L1). Adequate attention should be paid to the related complications in the use of immune checkpoint inhibitors. Nevertheless, further studies are needed to understand the underlying mechanisms of hypersensitivity reactions and establish standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.