Rationale: Sintilimab, an immune checkpoint inhibitor, enhances T-cell responses, leading to robust antitumor activity, and is approved for the treatment of lung cancer. While immune checkpoint inhibitors offer substantial clinical benefits, they are often associated with immune-related adverse events, particularly cutaneous toxicities. These skin reactions typically manifest as mild maculopapular rashes; however, more severe manifestations, such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), can occur. Both SJS and TEN are life-threatening conditions with high mortality rates. Patient concerns: The patient in this case is a 68-year-old male diagnosed with stage IVA non-small cell lung cancer, who has no detectable oncogenic mutations. He was treated with sintilimab (200 mg), pemetrexed disodium (500 mg/m 2 ), and cisplatin (75 mg/m 2 ). Following the third cycle of therapy, he developed widespread skin blisters, localized necrosis, and severe pain on the second day. Diagnoses: The patient’s symptoms – widespread skin blisters, localized necrosis, and severe pain – were indicative of SJS and TEN, which are immune-related cutaneous toxicities triggered by immunotherapy. Interventions: Immediate interventions were initiated, which included systemic corticosteroids, anti-inflammatory treatments, fluid replacement, and appropriate skin care measures. Outcomes: These interventions led to significant improvement in the immunotherapy-related dermatologic toxicity experienced by the patient. Lessons: This case underscores the importance for clinicians to remain vigilant regarding severe cutaneous toxicities such as SJS and TEN in patients undergoing sintilimab-based therapy. Prompt recognition and intervention are essential to mitigate the risks associated with these potentially life-threatening conditions.
Zhao et al. (Fri,) studied this question.