aprepitant and Stevens-Johnson-Syndrome

Although substantial progress has been made in the treatment of non-small-cell lung cancer (NSCLC) patients with immune checkpoint inhibitors (ICIs), severe immune-related adverse events (irAEs) sometimes occur. Here, we report a case of severe refractory pruritus after Stevens-Johnson syndrome (SJS) in a patient with NSCLC treated with nivolumab. The patient was a 76-year-old Japanese woman with advanced NSCLC treated with nivolumab. After the second dose, she experienced severe rash with mucous involvement. We diagnosed SJS and started 50mg of oral prednisolone (1mg/kg). The rash completely resolved after prednisolone was started, but we could not manage the severe pruritus with emollients, antihistamines, and steroids. Finally, we administered aprepitant, an oral neurokinin-1 receptor antagonist, for her refractory pruritus. Her symptoms improved within 5days. Severe refractory pruritus can arise from ICIs, and aprepitant may be a useful treatment.

Topics: Aged; Antibodies, Monoclonal; Antineoplastic Agents; Aprepitant; Carcinoma, Non-Small-Cell Lung; Female; Humans; Immunotherapy; Japan; Lung Neoplasms; Morpholines; Neurokinin-1 Receptor Antagonists; Nivolumab; Programmed Cell Death 1 Receptor; Pruritus; Remission Induction; Stevens-Johnson Syndrome