A case report : Pembrolizumab induced multiple immune-related adverse events in patients with adenoid cystic carcinoma of the parotid gland

Abstract

A 51-year-old female presented with pain in the right upper wrist. Computed tomography (CT) showed pathological fractures due to metastatic tumors. After an ontological work-up, the patient was diagnosed with stage IVc adenoid cystic carcinoma (ACC) of the parotid gland with a solid pattern, cT3N3bM1. An immunohistochemical examination of pathological sections revealed no expression of HER2. The use of immune checkpoint inhibitors (ICIs) was recommended based on comprehensive genomic profiling. A total of 108 days after starting pembrolizumab, she was urgently admitted due to severe general fatigue and anorexia with a diagnosis of fulminant type 1 diabetes mellitus. She also had hypothyroidism and interstitial nephritis, which are immune-related adverse events (irAEs). When immune checkpoint inhibitors are administered, close collaboration with healthcare professionals is essential to promptly identify early signs of irAEs.