Bian LF, Zheng C, Shi XL. Atezolizumab-induced anaphylactic shock in a patient with hepatocellular carcinoma undergoing immunotherapy: A case report. World J Clin Cases 2021; 9(16): 4110-4115 [PMID: 34141773 DOI: 10.12998/wjcc.v9.i16.4110]
Corresponding Author of This Article
Li-Fang Bian, MSN, Associate Chief Nurse, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qing Chun Road, Hangzhou 310003, Zhejiang Province, China. doggie_cc@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 6, 2021; 9(16): 4110-4115 Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4110
Atezolizumab-induced anaphylactic shock in a patient with hepatocellular carcinoma undergoing immunotherapy: A case report
Li-Fang Bian, Chao Zheng, Xiao-Lan Shi
Li-Fang Bian, Xiao-Lan Shi, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Chao Zheng, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Bian LF and Zheng C contributed equally to this work; Bian LF was the patient’s nurse, reviewed the literature, and contributed to manuscript drafting; Zheng C reviewed the literature, interpreted the imaging findings, and contributed to manuscript drafting; Shi XL contributed to manuscript drafting; all authors issued final approval for the version to be submitted.
Supported byMedical Health Science and Technology Project of Zhejiang Provincial Health Commission, China, No. 2020372769.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and accompanying images and clinical data.
Conflict-of-interest statement: There is no conflict of interest to report.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Fang Bian, MSN, Associate Chief Nurse, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qing Chun Road, Hangzhou 310003, Zhejiang Province, China. doggie_cc@zju.edu.cn
Received: January 31, 2021 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 Processing time: 102 Days and 21.5 Hours
Abstract
BACKGROUND
Atezolizumab is a programmed death ligand 1 (PD-L1) inhibitor, and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma (HCC). 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.
CASE SUMMARY
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.
CONCLUSION
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.
