Reactions 1704, p304 - 2 Jun 2018 X S Intracerebellar haemorrhage: case report A 78-year-old man developed intracerebellar haemorrhage following concomitant use of pembrolizumab and rivaroxaban [durations of treatments to reactions onsets not stated]. The man had a history significant for rheumatoid arthritis, atrial fibrillation, coronary artery disease, hypertension, diabetes mellitus, and hypothyroidism. His ongoing medications included rivaroxaban for atrial fibrillation [dosage and route not stated] and prednisone for rheumatoid arthritis. In 2009, he presented with a forehead melanoma and underwent surgeries over a period of three years. In August 2016, the forehead melanoma re-appeared along with bilateral periparotid lymphadenopathy, hence he started receiving immunotherapy with IV pembrolizumab 2 mg/kg every three weeks. He received six doses of pembrolizumab over a period of 4 months. However, during the therapy he developed spontaneous intracerebellar haemorrhage. The man’s pembrolizumab therapy was discontinued in December 2016. Subsequently, his haemorrhage resolved without any further complications. The development of intracerebellar haemorrhage was considered to be due to excessive anticoagulation due to their impaired metabolism from pembrolizumab therapy. Author comment: "Factor Xa inhibitors are metabolized by the hepatic CYP3/A4 system; thus, any effects of PD-1 inhibitors on this enzyme might have implications for the metabolism of these novel anticoagulants. Thus, the underlying risk factors for potential interactions with immunotherapy should be assessed carefully and treatments should be individualized for every patient". Puri A, et al. The safety of pembrolizumab in metastatic melanoma and rheumatoid arthritis. Melanoma Research 27: 519-523, No. 5, Oct 2017. Available from: URL: http://doi.org/10.1097/CMR.0000000000000387 - USA 803323077 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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