Download PDF
CC BY 4.0 · Brazilian Journal of Oncology 2017; 13(46): e-BJO20171346A94
DOI: 10.26790/BJO20171346A94
Relato De Caso

Necrólise epidérmica tóxica associada ao uso de nivolumabe: um relato de caso

Toxic epidermal necrolysis associated with the use of nivolumab: a case report
Sandro Laércio Reichow
1   Clínica Reichow, Blumenau, SC, Brasil
,
Carini Dagnoni
1   Clínica Reichow, Blumenau, SC, Brasil
,
Amanda Maieski
1   Clínica Reichow, Blumenau, SC, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints All articles of this category

RESUMO

Imunoterapia com nivolumabe para o tratamento de segunda linha para câncer de pulmão avançado demonstrou menor toxicidade e melhores desfechos, em comparação com quimioterapia. Quando ocorrem, os eventos adversos são geralmente imuno-mediados, podendo acometer qualquer órgão e, na maioria das vezes são manejáveis, entretanto raros casos podem ser fatais. Há poucos relatos na literatura de necrólise epidérmica tóxica ocasionada por nivolumabe. O objetivo do presente relato de caso é descrever a história clínica de uma paciente que desenvolveu esta reação após uso desta medicação e discorrer uma breve revisão da literatura sobre sua etiologia e medidas terapêuticas, tendo em vista sua raridade e gravidade. São parte essencial do sucesso do tratamento a detecção precoce dos sintomas/sinais e rápido manejo dos mesmos.

ABSTRACT

Immunotherapy with nivolumab for second-line treatment for advanced lung cancer demonstrated lower toxicity and better outcomes compared to chemotherapy. When they occur, adverse events are usually immune-related, can occur in any organ, and most of the time they are manageable, although, in rare cases can be fatal. There are few reports in the literature of toxic epidermal necrolysis caused by nivolumab. The aim of the present case report is to describe the clinical history of a patient who developed this reaction after using this medication and to discuss a brief review of the literature on its etiology and therapeutic measures, considering its rarity and severity. Early detection of the symptoms/signs and their rapid management are an essential part of the treatment success.

Keywords:

Immunotherapy - Nivolumab - Lung neoplasms - Stevens-Johnson Syndrome

Descritores:

Immunoterapia - Nivolumabe - Neoplasias pulmonares - Síndrome de Stevens-Johnson


Publication History

Received: 10 June 2017

Accepted: 19 December 2017

Article published online:
25 February 2025

© 2017. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
Sandro Laércio Reichow, Carini Dagnoni, Amanda Maieski. Necrólise epidérmica tóxica associada ao uso de nivolumabe: um relato de caso. Brazilian Journal of Oncology 2017; 13: e-BJO20171346A94.
DOI: 10.26790/BJO20171346A94
 

  • REFERÊNCIAS

  • 1 Curran MA, Montalvo W, Yagita H, Allison JP. PD-1 and CTLA-4 combination blockade expands infiltrating T cells and reduces regulatory T and myeloid cells within B16 melanoma tumors. Proc Natl Acad Sci USA 2010; 107 (09) 4275-80
    PubMedSearch in Google Scholar
  • 2 Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE. et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 2015; 373 (17) 1627-39
    CrossrefPubMedSearch in Google Scholar
  • 3 Robert C, Schachter J, Long GV, Arance A, Grob JJ, Mortier L. et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med 2015; 372 (26) 2521-32
    PubMedSearch in Google Scholar
  • 4 Nayar N, Briscoe K, Fernandez-Penas P. Toxic epidermal necrolysis-like reaction with severe satellite cell necrosis associated with nivolumab in a patient with ipilimumab refractory metastatic melanoma. J Immunother 2016; 39 (03) 149-52
    PubMedSearch in Google Scholar
  • 5 Wolff K, Johnson RA, Saavedra AP. Dermatologia de Fitzpatrick: atlas e texto. São Paulo: McGraw-Hill; 2015. Erupções cutâneas graves e potencialmente letais no paciente agudamente enfermo 137-40
    Search in Google Scholar
  • 6 Topalian SL, Sznol M, McDermott DF, Kluger HM, Carvajal RD, Sharfman WH. et al. Survival, durable tumor remission, and long-term safety in patients with advanced melanoma receiving nivolumab. J Clin Oncol 2014; 32 (10) 1020-30
    CrossrefPubMedSearch in Google Scholar
  • 7 Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S. et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med 2015; 373 (19) 1803-13
    CrossrefPubMedSearch in Google Scholar
  • 8 Younes A, Santoro A, Shipp M, Zinzani PL, Timmerman JM, Ansell S. et al. Nivolumab for classical Hodgkin’s lymphoma after failure of both autologous stem-cell transplantation and brentuximab vedotin: a multicentre, multicohort, single--arm phase 2 trial. Lancet Oncol 2016; 17 (09) 1283-94
    CrossrefPubMedSearch in Google Scholar
  • 9 Ferris RL, Blumenschein GR, Fayette J, Guigay J, Colevas AD, Licitra LF. et al. Further evaluations of nivolumab (nivo) versus investigator’s choice (IC) chemotherapy for recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN): CheckMate 141 [abstract]. J Clin Oncol. 2016;34 (Suppl): abstr 6009
  • 10 Weber JS, Antonia SJ, Topalian SL, Schadendorf D, Larkin JMG, Sznol M. et al. Safety profile of nivolumab (NIVO) in patients (pts) with advanced melanoma (MEL): a pooled analysis [abstract]. J Clin Oncol. 2015; 33 (Suppl):abstr 9018
  • 11 Bristol Myers Squibb. Opdivo (Nivolumab) Product Information. OPDIVO (Nivolumab) injection, for intravenous use. Initial U.S. Approval: 2014 [Internet]. [cited 2017 Dec 19]. Available from http://packageinserts.bms.com/pi/pi_opdivo.pdf
  • 12 Oliveira A, Sanches M, Selores M. Stevens-Johnson syndrome and toxic epidermal necrolysis. Acta Med Port 2011; 24 Suppl 4 995-1002
    PubMedSearch in Google Scholar
  • 13 Attia P, Phan GQ, Maker AV, Robinson MR, Quezado MM, Yang JC. et al. Autoimmunity correlates with tumor regression in patients with metastatic melanoma treated with anti-cytotoxic T-lymphocyte antigen-4. J Clin Oncol 2005; 23 (25) 6043-53
    PubMedSearch in Google Scholar
  • 14 Spain L, Diem S, Larkin J. Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev 2016; 44: 51-60
    CrossrefPubMedSearch in Google Scholar
  • 15 OPDIVO. [Immune-Mediated Adverse Reactions Management Guide]. Princeton, NJ: Bristol-Myers Squibb; 2015
    Search in Google Scholar