Cytokine Release Syndrome with Relative Adrenal Insufficiency Induced by Ipilimumab and Nivolumab Combination Therapy for Clear Cell Renal Cell Carcinoma

Kohei Yamamoto; Shinsuke Shiotsu; Misaki Sasakura; Shunya Tanaka; Shiho Goda; Taisuke Tsuji; Tatsuya Yuba; Chieko Takumi; Noriya Hiraoka

doi:10.2169/internalmedicine.3115-23

Kohei Yamamoto, Shinsuke Shiotsu, Misaki Sasakura, Shunya Tanaka, Shiho Goda, Taisuke Tsuji, Tatsuya Yuba, Chieko Takumi, Noriya Hiraoka

Author information

Kohei Yamamoto
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Shinsuke Shiotsu
Department of clinical oncology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Misaki Sasakura
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Shunya Tanaka
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Shiho Goda
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Taisuke Tsuji
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Tatsuya Yuba
Department of infection control, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Chieko Takumi
Department of clinical oncology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Noriya Hiraoka
Department of respiratory medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan

Keywords: cytokine release syndrome, immune-related adverse event, ipilimumab, nivolumab, adrenal insufficiency

JOURNAL OPEN ACCESS Advance online publication

Article ID: 3115-23

DOI https://doi.org/10.2169/internalmedicine.3115-23

Details

Abstract

Combination therapy with ipilimumab and nivolumab is indicated for many types of cancers; however, several patients experience immune-related adverse events (irAEs). We herein report a case of cytokine release syndrome (CRS) in a 63-year-old woman with stage IV left clear cell renal cell carcinoma. Our patient developed CRS while taking prednisolone, 43 days after the start of ipilimumab and nivolumab administration. The patient was treated with steroid pulse therapy, which improved the symptoms of shock and respiratory failure. Increased vascular permeability and relative adrenal insufficiency are considered to be the main pathogeneses. The early administration of high-dose steroids is crucial as a replacement for corticosteroids.

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