• Kazuyuki Hamada, Kiyoshi Yoshimura, Kazuhiko Oshinomi, Yuya Hirasawa, Hirotsugu Ariizumi, Ryotaro Ohkuma, Midori Shida, Yutaro Kubota, Hiroto Matsui, Tomoyuki Ishiguro, Takehiko Sambe, Hiroo Ishida, Atsushi Horiike, Satoshi Wada, Sanju Iwamoto, Naoki Uchida, Yoshio Ogawa, Shinichi Kobayashi, and Takuya Tsunoda.
• Department of Medicine, Division of Medical Oncology, Showa University School of Medicine, Tokyo, Japan.
• Medicine (Baltimore). 2022 Jan 14; 101 (2): e28339.

RationaleBladder cancer is one of the most common cancers worldwide. The anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab, which is an immune checkpoint inhibitor (ICI), has improved survival in bladder cancer. We report a case of bladder cancer that had a high antitumor effect with anti-programmed cell death PD-1 antibody pembrolizumab, an ICI, but asthma occurred an immune-related adverse event (irAE).Patient ConcernsA 70-year-old female patient was diagnosed as unresectable bladder cancer who was indicated for ICI treatment.DiagnosisAfter ICI administration as a treatment for bladder cancer, the patient had a grade 3 asthma attack. Cytotoxic T lymphocyte antigen 4 (CTLA-4) in CD4+ FOX3+ T cells was upregulated in the early phase before the development of asthma attacks. Moreover, T-cell immunoglobulin and mucin domain 3 (TIM-3) was upregulated in all memory T cells among CD4+ T cells. However, no change in the expression of TIM-3 was observed in any CD8+ T-cell subtype. In contrast, the proportion of CD161- T helper 17 cell (Th17) cells increased.InterventionsThe patient was treated with betamethasone, montelukast, salbutamol nebulization, and a combination of salmeterol (50 μg) and fluticasone (500 μg) (SFC).OutcomesThe patient's wheezing resolved, and her peak flow rate reached 100% of the predicted value; therefore, the patient continued treatment with SFC and montelukast and was discharged from the hospital.ConclusionIncreases in CTLA-4 and TIM-3 expression in CD4+ T cells (not CD8+), as well as an increase in Th17 cells, may reflect asthma-related inflammation activity. Immune-related adverse events during immune checkpoint inhibitor administration may be predictive markers of antitumor efficacy.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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