Recently, combination therapy including immune checkpoint inhibition (ICI) has proven to be effective as first-line therapy for patients with metastatic renal cell carcinoma. Although the first-line combination therapies with ICI have shown clinical benefit, a number of patients require second-line treatment. We report a 60-year-old man with metastatic renal cell carcinoma who was treated with pazopanib soon after nivolumab plus ipilimumab combination therapy. He experienced Grade 3 disseminated intravascular coagulation (DIC). We suspect that this was caused by an interaction between pazopanib and nivolumab even though ICI therapy was discontinued. He was treated with thrombomodulin and platelet transfusion and recovered from DIC. Treatment with pazopanib was subsequently restarted. No evidence of DIC was observed thereafter. This severe adverse reaction may have been induced by an interaction between activated proinflammatory immune cells and cytokines from an exacerbated inflammatory state and pazopanib. This report highlights the need to perform careful monitoring of patients who receive molecular targeted therapy after ICI-based immunotherapy.

中文翻译：

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转移性肾细胞癌患者接受纳武单抗加伊匹单抗联合治疗后帕唑帕尼诱导的弥散性血管内凝血。

最近，包括免疫检查点抑制（ICI）在内的联合疗法已被证明作为转移性肾细胞癌患者的一线疗法是有效的。尽管一线联合疗法与 ICI 已显示出临床益处，但许多患者需要二线治疗。我们报道了一名患有转移性肾细胞癌的 60 岁男性，他在纳武单抗加伊匹单抗联合治疗后不久接受了帕唑帕尼治疗。他经历了 3 级弥散性血管内凝血 (DIC)。我们怀疑这是由帕唑帕尼和纳武单抗之间的相互作用引起的，即使 ICI 治疗已停止。他接受了血栓调节蛋白和血小板输注治疗，并从 DIC 中康复。随后重新开始帕唑帕尼治疗。此后没有观察到 DIC 的证据。这种严重的不良反应可能是由激活的促炎性免疫细胞和加剧炎症状态的细胞因子与帕唑帕尼之间的相互作用引起的。该报告强调需要对基于 ICI 的免疫治疗后接受分子靶向治疗的患者进行仔细监测。