Thrombocytopenia as an Immune-Related Adverse Event in Malignant Pleural Mesothelioma: A Case Report

Our plain-English summary of Thrombocytopenia as an Immune-Related Adverse Event in Malignant Pleural Mesothelioma: A Case Report, by T. Tanaka, S. Asakura, K. Hisamatsu, et al (JTO Clinical and Research Reports, 2022).

The study

• Authors: T. Tanaka, S. Asakura, K. Hisamatsu, N. Fujimoto
• Journal: JTO Clinical and Research Reports
• Published: 2022;3(7):100351
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 69-year-old man presented with a pulmonary opacity at a regular medical check-up. He had been exposed to asbestos in a chemical fiber manufacturing setting. Result of positron emission tomography with computed tomography (CT) revealed fluorodeoxyglucose accumulations along the right pleura in areas with multiple nodules and irregular pleural thickening. On the basis of analysis of a CT-guided needle biopsy result, he had been diagnosed with having epithelioid malignant pleural mesothelioma. He received neoadjuvant chemotherapy, and subsequently, a pleurectomy and decortication. After 6 months, malignant pleural mesothelioma recurred with multiple tumors in the pleural cavity. Nivolumab was administered as salvage immunotherapy. A CT scan result revealed marked tumor reduction; however, his platelet count was low (8000/μL), and he was diagnosed with having nivolumab-induced immune thrombocytopenia. Oral prednisone and thrombopoietin receptor agonist were delivered, and the platelet count improved; therefore, a sustained cycle of nivolumab was resumed. This case revealed that nivolumab could be readministered for continued antitumor effects, with careful management of immune-related adverse events.

© 2022 The Authors.

In plain English

This case report described one 69-year-old man, treated at a hospital in Okayama, Japan, who had epithelioid malignant pleural mesothelioma. He had been exposed to asbestos for 3 years while working in a chemical fiber manufacturing setting. The article does not name a fiber type. He received three cycles of chemotherapy (cisplatin and pemetrexed) and then surgery (pleurectomy with decortication). The cancer came back 6 months after surgery, and he was given the immunotherapy drug nivolumab every 2 weeks. After four cycles, a CT scan showed marked tumor shrinkage. After the ninth cycle, his platelet count was 8000 per microliter, with no bleeding. He was diagnosed with nivolumab-induced immune thrombocytopenia, and nivolumab was stopped. After treatment with prednisone and a thrombopoietin receptor agonist, his platelet count was 200,000 per microliter on day 24. Nivolumab was restarted 3 months after the thrombocytopenia began. At the 14th cycle, the thrombocytopenia had not reappeared and the mesothelioma had not worsened. The authors concluded that nivolumab could be given again, with careful management of immune-related side effects. This report describes one patient, not a rate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 69-year-old man in Japan (Okayama Rosai Hospital) with epithelioid malignant pleural mesothelioma, clinical stage T3N0M0. He had type 2 diabetes and a history of smoking 20 cigarettes a day for 18 years.
• Exposure: Asbestos exposure for 3 years while working in a chemical fiber manufacturing setting (fiber type not stated). The treatment studied was nivolumab 240 mg every 2 weeks as salvage immunotherapy.
• Main results:
  • The mesothelioma recurred 6 months after pleurectomy with decortication, with multiple tumors in the pleural cavity.
  • After four cycles of nivolumab, CT showed marked tumor reduction in this patient.
  • After the ninth cycle, the patient's platelet count was 8000 per microliter, without anemia or leukopenia, and nivolumab was stopped. The article text prints the unit as /mL. The same abstract sentence in PubMed reads 8000/μL, so the micro symbol was lost in extraction.
  • The low platelet count was not associated with bleeding.
  • Bone marrow biopsy showed no megakaryocytic abnormalities or chromosomal aberrations. Platelet-associated IgG was elevated and antiplatelet antibodies were negative. The patient was diagnosed with nivolumab-induced immune thrombocytopenia.
  • With oral prednisone (0.5 mg/kg/day), the platelet count improved to 50,000 per microliter on day 3.
  • A thrombopoietin receptor agonist was added as prednisone was tapered, and the platelet count was 200,000 per microliter on day 24.
  • Nivolumab was resumed 3 months after onset of the thrombocytopenia (10th cycle). At the 14th cycle there was no reappearance of the thrombocytopenia and no worsening of the mesothelioma.
• The authors' conclusion: The authors concluded that, in this case, nivolumab could be given again and continued as a mesothelioma treatment, with careful management of immune-related adverse events.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Pleural Thickening, Needle Biopsy, Epithelioid, Neoadjuvant Chemotherapy, Pleural Cavity, Nivolumab (Opdivo).

Related studies

• Socio-economic, infrastructural and health-related risk factors associated with adverse heat-health effects reportedly experienced during hot weather in South Africa — C.Y. Wright, F. Dominick, et al. (2019)
• Asbestos exposure and asbestos-related pleural and parenchymal disease. Associations with immune imbalance — N.L. Sprince, L.C. Oliver, et al. (1991)
• The threshold length for fiber-induced acute pleural inflammation: shedding light on the early events in asbestos-induced mesothelioma — A. Schinwald, F.A. Murphy, et al. (2012)
• BAP1 mutation is a frequent somatic event in peritoneal malignant mesothelioma — H. Alakus, S.E. Yost, et al. (2015)
• Epithelial to Mesenchymal Transition in Human Mesothelial Cells Exposed to Asbestos Fibers: Role of TGF-β as Mediator of Malignant Mesothelioma Development or Metastasis via EMT Event — S. Turini, L. Bergandi, et al. (2019)
• Early lung events following low-dose asbestos exposure — R. Bégin, M. Rola-Pleszczynski, et al. (1981)

Browse more research in JTO Clinical and Research Reports, or return to medical research.