Pembrolizumab Induced Grade 4 Skin irAEs with NonSmall Cell Lung Cancer: Case Report and Review of Literature

Objectives: Immune Checkpoint Inhibitors (ICIs), including pembrolizumab, have exhibited substantial benefits in the treatment of several types of cancers. However, treatment with ICIs is often accompanied by immune-related adverse events (irAEs), we report a rare case of pembrolizumab induced grade 4 skin irAEs with non-small cell lung cancer (NSCLC). Materials and Methods: We report about an advanced NSCLC patient with 4 grade skin irAEs, after the treatment of pembrolizumab. We also compared statistical laboratory results and imageological examinations to discuss the relative factors of the patient’s curative effect and adverse reactions. Results and Conclusion: This case is the first report of a 4-degree skin reaction with the pembrolizumab in patients with NSCLC, and the patient has the characteristics of good curative effect and severe adverse reactions. The patient experienced grade 4 skin irAEs after five cycles of pembrolizumab. Increased eosinophil levels are associated with increased skin irAEs in patients. However, CEA and Cytokeratin 19 fragment changes did not show a significant correlation with their skin irAEs and efficacy. The study of this case can provide some reference for efficacy evaluation and treatment after severe skin irAEs in patients with NSCLC.