{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:51:09Z","timestamp":1793641869700,"version":"4.5.1"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum des Saarlandes und Medizinische Fakult\u00e4t der Universit\u00e4t des Saarlandes"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Secondary hemophagocytic lymphohistiocytosis (HLH) associated with pembrolizumab is a rare immune-related adverse event (irAE). It features a potential life-threatening status including fever and a hyperinflammatory reaction caused by natural killer cells, CD8\u2009+\u2009cytotoxic T cells, and antigen-presenting cells leading to multiorgan failure. Secondary HLH is described for immune checkpoint inhibitor (ICI) therapy. Most descriptions refer to patients with melanoma or lung cancer. We report about a 32\u00a0year-old patient with secondary HLH associated with adjuvant pembrolizumab therapy according to the Keynote-522 protocol. It was successfully treated with prednisolone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a literature review in PubMed including the terms \u201cHLH OR hemophagocytic lymphohistiocytosis AND breast cancer\u201d. We found four other cases meeting the inclusion criteria (abstract available in English, breast cancer patient, HLH related to ICI therapy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Apart from the case report, the review featured main aspects about the\u00a0diagnosis (HScore, histopathological assessment), onset of HLH, and medical treatment. The review indicated that secondary ICI induced HLH in breast cancer patients may be associated with complete response according to their tumor burden. Most cases are reported with an onset of secondary HLH within the neoadjuvant treatment phase and were treated analogously to the Keynote-522 protocol. Our case showed an onset almost 1\u00a0year after the initiation of pembrolizumab therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gyneco-oncologist should be aware of secondary HLH during pembrolizumab therapy and should assess patients with persistent fever using the HScore to diagnose secondary HLH early.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08078-4","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T04:41:38Z","timestamp":1751517698000},"page":"1813-1820","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Secondary hemophagocytic lymphohistiocytosis associated with adjuvant pembrolizumab therapy in a young patient with triple-negative breast cancer: a case report with literature review"],"prefix":"10.1007","volume":"312","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9334-4774","authenticated-orcid":false,"given":"G. L.","family":"Olmes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. P.","family":"Nigdelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Haj","family":"Hamoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.-F.","family":"Solomayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bewarder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. T.","family":"Bittenbring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Kranzh\u00f6fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Thurner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.-J.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Seibold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Doerk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"8078_CR1","volume-title":"Stat Pearls","author":"S Konkol","year":"2024","unstructured":"Konkol S, Rai M (2024) Lymphohistiocytosis. Stat Pearls. StatPearls Publishing, Treasure Island, FL"},{"key":"8078_CR2","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1056\/NEJMra2314005","volume":"392","author":"J-I Henter","year":"2025","unstructured":"Henter J-I (2025) Hemophagocytic lymphohistiocytosis. N Engl J Med 392:584\u2013598. https:\/\/doi.org\/10.1056\/NEJMra2314005","journal-title":"N Engl J Med"},{"key":"8078_CR3","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1136\/ard-2023-224123","volume":"82","author":"B Shakoory","year":"2023","unstructured":"Shakoory B, Geerlinks A, Wilejto M et al (2023) The 2022 EULAR\/ACR points to consider at the early stages of diagnosis and management of suspected haemophagocytic lymphohistiocytosis\/macrophage activation syndrome (HLH\/MAS). Ann Rheum Dis 82:1271\u20131285. https:\/\/doi.org\/10.1136\/ard-2023-224123","journal-title":"Ann Rheum Dis"},{"key":"8078_CR4","doi-asserted-by":"publisher","first-page":"e1137","DOI":"10.1097\/CCM.0000000000004581","volume":"48","author":"C Knaak","year":"2020","unstructured":"Knaak C, Schuster FS, Nyvlt P et al (2020) Treatment and mortality of hemophagocytic lymphohistiocytosis in adult critically ill patients: a systematic review with pooled analysis. Crit Care Med 48:e1137\u2013e1146. https:\/\/doi.org\/10.1097\/CCM.0000000000004581","journal-title":"Crit Care Med"},{"key":"8078_CR5","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.3390\/jcm12051985","volume":"12","author":"L Diaz","year":"2023","unstructured":"Diaz L, Jauzelon B, Dillies A-C et al (2023) Hemophagocytic lymphohistiocytosis associated with immunological checkpoint inhibitors: a pharmacovigilance study. J Clin Med 12:1985. https:\/\/doi.org\/10.3390\/jcm12051985","journal-title":"J Clin Med"},{"key":"8078_CR6","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1056\/NEJMoa2202809","volume":"387","author":"J Cortes","year":"2022","unstructured":"Cortes J, Rugo HS, Cescon DW et al (2022) Pembrolizumab plus chemotherapy in advanced triple-negative breast cancer. N Engl J Med 387:217\u2013226. https:\/\/doi.org\/10.1056\/NEJMoa2202809","journal-title":"N Engl J Med"},{"key":"8078_CR7","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2022-005841","volume":"11","author":"LL Liu","year":"2023","unstructured":"Liu LL, Skribek M, Harmenberg U, Gerling M (2023) Systemic inflammatory syndromes as life-threatening side effects of immune checkpoint inhibitors: case report and systematic review of the literature. J Immunother Cancer 11:e005841. https:\/\/doi.org\/10.1136\/jitc-2022-005841","journal-title":"J Immunother Cancer"},{"key":"8078_CR8","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1056\/NEJMoa1910549","volume":"382","author":"P Schmid","year":"2020","unstructured":"Schmid P, Cortes J, Pusztai L et al (2020) Pembrolizumab for early triple-negative breast cancer. N Engl J Med 382:810\u2013821. https:\/\/doi.org\/10.1056\/NEJMoa1910549","journal-title":"N Engl J Med"},{"key":"8078_CR9","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.maturitas.2020.11.006","volume":"145","author":"MP Nigdelis","year":"2021","unstructured":"Nigdelis MP, Karamouzis MV, Kontos M et al (2021) Updates on the treatment of invasive breast cancer: Quo Vadimus? Maturitas 145:64\u201372. https:\/\/doi.org\/10.1016\/j.maturitas.2020.11.006","journal-title":"Maturitas"},{"key":"8078_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-025-08028-0","author":"N Tauber","year":"2025","unstructured":"Tauber N, Amann N, Dannehl D et al (2025) Therapy of early breast cancer: current status and perspectives. Arch Gynecol Obstet. https:\/\/doi.org\/10.1007\/s00404-025-08028-0","journal-title":"Arch Gynecol Obstet"},{"key":"8078_CR11","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.ejca.2019.07.014","volume":"122","author":"JM Michot","year":"2019","unstructured":"Michot JM, Lazarovici J, Tieu A et al (2019) Haematological immune-related adverse events with immune checkpoint inhibitors, how to manage? Eur J Cancer 122:72\u201390. https:\/\/doi.org\/10.1016\/j.ejca.2019.07.014","journal-title":"Eur J Cancer"},{"key":"8078_CR12","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12877-023-04625-3","volume":"24","author":"C Zhai","year":"2024","unstructured":"Zhai C, Jin X, You L et al (2024) Hemophagocytic lymphohistiocytosis following pembrolizumab and bevacizumab combination therapy for cervical cancer: a case report and systematic review. BMC Geriatr 24:32. https:\/\/doi.org\/10.1186\/s12877-023-04625-3","journal-title":"BMC Geriatr"},{"key":"8078_CR13","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1136\/jmedgenet-2018-105485","volume":"56","author":"H Al-Samkari","year":"2019","unstructured":"Al-Samkari H, Snyder GD, Nikiforow S et al (2019) Haemophagocytic lymphohistiocytosis complicating pembrolizumab treatment for metastatic breast cancer in a patient with the PRF1A91V gene polymorphism. J Med Genet 56:39\u201342. https:\/\/doi.org\/10.1136\/jmedgenet-2018-105485","journal-title":"J Med Genet"},{"key":"8078_CR14","doi-asserted-by":"publisher","first-page":"136","DOI":"10.3892\/ol.2025.14882","volume":"29","author":"Y Kawamura","year":"2025","unstructured":"Kawamura Y, Shimomura A, Taniyama T et al (2025) Preoperative pembrolizumab-induced hemophagocytic lymphohistiocytosis in a patient with breast cancer: a case report. Oncol Lett 29:136. https:\/\/doi.org\/10.3892\/ol.2025.14882","journal-title":"Oncol Lett"},{"key":"8078_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2024.102896","volume":"110","author":"CS Walmsley","year":"2025","unstructured":"Walmsley CS, Schoepflin Z, De Brabandt C et al (2025) Hemophagocytic lymphohistiocytosis associated with immune checkpoint inhibitor use: a review of the current knowledge and future directions. Blood Cells Mol Dis 110:102896. https:\/\/doi.org\/10.1016\/j.bcmd.2024.102896","journal-title":"Blood Cells Mol Dis"},{"key":"8078_CR16","doi-asserted-by":"publisher","first-page":"1394543","DOI":"10.3389\/fonc.2024.1394543","volume":"14","author":"L Patton","year":"2024","unstructured":"Patton L, Monteith B, Heffernan P et al (2024) Hemophagocytic lymphohistiocytosis\/cytokine release syndrome secondary to neoadjuvant pembrolizumab for triple-negative breast cancer: a case study. Front Oncol 14:1394543. https:\/\/doi.org\/10.3389\/fonc.2024.1394543","journal-title":"Front Oncol"},{"key":"8078_CR17","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","volume":"35","author":"S Loibl","year":"2024","unstructured":"Loibl S, Andr\u00e9 F, Bachelot T et al (2024) Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol 35:159\u2013182. https:\/\/doi.org\/10.1016\/j.annonc.2023.11.016","journal-title":"Ann Oncol"},{"key":"8078_CR18","doi-asserted-by":"publisher","first-page":"2613","DOI":"10.1002\/art.38690","volume":"66","author":"L Fardet","year":"2014","unstructured":"Fardet L, Galicier L, Lambotte O et al (2014) Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol Hoboken NJ 66:2613\u20132620. https:\/\/doi.org\/10.1002\/art.38690","journal-title":"Arthritis Rheumatol Hoboken NJ"},{"key":"8078_CR19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s41199-020-0050-3","volume":"5","author":"J Kalmuk","year":"2020","unstructured":"Kalmuk J, Puchalla J, Feng G et al (2020) Pembrolizumab-induced Hemophagocytic lymphohistiocytosis: an immunotherapeutic challenge. Cancers Head Neck 5:3. https:\/\/doi.org\/10.1186\/s41199-020-0050-3","journal-title":"Cancers Head Neck"},{"key":"8078_CR20","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1038\/s41571-019-0218-0","volume":"16","author":"F Martins","year":"2019","unstructured":"Martins F, Sofiya L, Sykiotis GP et al (2019) Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol 16:563\u2013580. https:\/\/doi.org\/10.1038\/s41571-019-0218-0","journal-title":"Nat Rev Clin Oncol"},{"key":"8078_CR21","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/PPO.0000000000000500","volume":"27","author":"FM Howard","year":"2021","unstructured":"Howard FM, Olopade OI (2021) Epidemiology of triple-negative breast cancer: a review. Cancer J 27:8\u201316. https:\/\/doi.org\/10.1097\/PPO.0000000000000500","journal-title":"Cancer J"},{"key":"8078_CR22","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1007\/s00404-015-3859-y","volume":"293","author":"P Kumar","year":"2016","unstructured":"Kumar P, Aggarwal R (2016) An overview of triple-negative breast cancer. Arch Gynecol Obstet 293:247\u2013269. https:\/\/doi.org\/10.1007\/s00404-015-3859-y","journal-title":"Arch Gynecol Obstet"},{"key":"8078_CR23","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1007\/s10552-009-9331-1","volume":"20","author":"KF Trivers","year":"2009","unstructured":"Trivers KF, Lund MJ, Porter PL et al (2009) The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control CCC 20:1071\u20131082. https:\/\/doi.org\/10.1007\/s10552-009-9331-1","journal-title":"Cancer Causes Control CCC"},{"key":"8078_CR24","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s00404-022-06902-9","volume":"308","author":"AS Hoffmann","year":"2023","unstructured":"Hoffmann AS, Hennigs A, Feisst M et al (2023) Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017. Arch Gynecol Obstet 308:219\u2013229. https:\/\/doi.org\/10.1007\/s00404-022-06902-9","journal-title":"Arch Gynecol Obstet"},{"key":"8078_CR25","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/pbc.21039","volume":"48","author":"J-I Henter","year":"2007","unstructured":"Henter J-I, Horne A, Aric\u00f3 M et al (2007) HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 48:124\u2013131. https:\/\/doi.org\/10.1002\/pbc.21039","journal-title":"Pediatr Blood Cancer"},{"key":"8078_CR26","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1016\/S0140-6736(13)61048-X","volume":"383","author":"M Ramos-Casals","year":"2014","unstructured":"Ramos-Casals M, Brito-Zer\u00f3n P, L\u00f3pez-Guillermo A et al (2014) Adult haemophagocytic syndrome. Lancet Lond Engl 383:1503\u20131516. https:\/\/doi.org\/10.1016\/S0140-6736(13)61048-X","journal-title":"Lancet Lond Engl"},{"key":"8078_CR27","doi-asserted-by":"publisher","first-page":"2275846","DOI":"10.1080\/2162402X.2023.2275846","volume":"12","author":"M Marhold","year":"2023","unstructured":"Marhold M, Udovica S, Halstead A et al (2023) Emergence of immune-related adverse events correlates with pathological complete response in patients receiving pembrolizumab for early triple-negative breast cancer. Oncoimmunology 12:2275846. https:\/\/doi.org\/10.1080\/2162402X.2023.2275846","journal-title":"Oncoimmunology"},{"key":"8078_CR28","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.21037\/atm-20-8124","volume":"9","author":"S Alexander","year":"2021","unstructured":"Alexander S, Swami U, Kaur A et al (2021) Safety of immune checkpoint inhibitors in patients with cancer and pre-existing autoimmune disease. Ann Transl Med 9:1033. https:\/\/doi.org\/10.21037\/atm-20-8124","journal-title":"Ann Transl Med"},{"key":"8078_CR29","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.2169\/internalmedicine.3889-19","volume":"59","author":"Y Akagi","year":"2020","unstructured":"Akagi Y, Awano N, Inomata M et al (2020) Hemophagocytic Lymphohistiocytosis in a Patient with Rheumatoid Arthritis on Pembrolizumab for Lung adenocarcinoma. Intern Med Tokyo Jpn 59:1075\u20131080. https:\/\/doi.org\/10.2169\/internalmedicine.3889-19","journal-title":"Intern Med Tokyo Jpn"},{"key":"8078_CR30","doi-asserted-by":"publisher","first-page":"12641","DOI":"10.3390\/ijms232012641","volume":"23","author":"L Alserawan","year":"2022","unstructured":"Alserawan L, Anguera G, Zamora Atenza C et al (2022) Association between changes in the patterns of antinuclear autoantibodies during immune checkpoint inhibition therapy and the development of severe immune related adverse events. Int J Mol Sci 23:12641. https:\/\/doi.org\/10.3390\/ijms232012641","journal-title":"Int J Mol Sci"},{"key":"8078_CR31","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1182\/blood.2018894618","volume":"133","author":"P La Ros\u00e9e","year":"2019","unstructured":"La Ros\u00e9e P, Horne A, Hines M et al (2019) Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood 133:2465\u20132477. https:\/\/doi.org\/10.1182\/blood.2018894618","journal-title":"Blood"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08078-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-025-08078-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08078-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T07:29:27Z","timestamp":1762327767000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-025-08078-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,3]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["8078"],"URL":"https:\/\/doi.org\/10.1007\/s00404-025-08078-4","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,3]]},"assertion":[{"value":"5 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"GL Olmes received grants form AstraZeneca (Cambridge, UK), Medconcept (Neustadt an der Weinstra\u00dfe, Germany), University Medical Center Freiburg (Germany), Der PRIVATARZT Gyn\u00e4kologie (MiM Verlagsgesellschaft mbH, Neu-Isenburg, Germany) and RG \u00c4rztefortbildung GmbH, membership of DGGG (Berlin, Germany), AGE (Buchholz, Germany), and AGEM (Berlin, Germany) and scientific colloboration with Karl Storz (Tuttlingen, Germany). MP Nigdelis received honoraria from RG \u00c4rztefortbildung GmbH, as well as travel grants from Organon (Jersey City, USA). B Haj Hamoud received travel grants from Gedeon Richter, AstraZeneca (Cambridge, UK); Johnson & Johnson (New Brunswick, NJ, USA) and Storz (Tuttlingen, Germany) and is member of DGGG (Berlin, Germany), AGE (Buchholz, Germany) and Stiftung Endometriose Forschung (Westerstede, Germany) EF Solomayer is receiving: grants from the University of Saarland, and Storz and Erbe; personal fees and other compensation from Roche (Basel, Switzerland), Pfizer (New York City, NY, USA), Celgene (Summit USA), Amgen (Thousand Oaks, CA, USA), and Astra Zeneca (Cambridge, UK); and other fees from Esai (Tokyo, Japan), Johnson & Johnson (New Brunswick, NJ, USA), Novartis (Basel, Switzerland), Tesaro (Waltham, MA, USA), Teva (Petach Tikwa, Israel), Medac GmbH (Wedel, Germany), MSD (Kenilworth, NJ, USA), Vifor (Sankt Gallen, Switzerland), Gedeon Richter (Budapest, Hungary), Takeda (Tokyo, Japan), and AGE (Buchholz, Germany); other potential conflicts: Clovis Oncology (Boulder, Colorado, USA), Genomic Health (Redwood City, California, USA), Jenapharm (Jena, Germany), Matramed (Bexbach, Germany), Mentor (Minneapolis, Minnesota, USA), Pharma Mar (Mardid, Spain), Samsung (Suwon, Southkorea), University of Saarland (Saarbr\u00fccken, Germany), DGGG (Berlin, Germany), AGO (Taufkirchen, Germany), AGUB (Taufkirchen, Germany), DGS (Berlin, Germany), DKG (Berlin, Germany), Saarl\u00e4ndisches Tumorzentrum am UKS e.V., University of Saarland, Homburg, Germany), Saarl\u00e4ndische Krebsgesellschaft (Saarbr\u00fccken, Germany), Stiftung Endometriose Forschung (Westerstede, Germany), ESGE (Leuven, Belgium), ETC (Saarbr\u00fccken, Germany), DEGUM (Berlin, Germany), Deutsche Kontinenzgesellschaft (Frankfurt, Germany), BLFG (Berlin, Germany), Medconcept (Neustadt an der Weinstra\u00dfe, Germany), Thieme (Stuttgart, Germany). M Bewarder received honoraria from AstraZeneca, Janssen and BMS. JT Bittenbring received personal fees from Roche, Abbvie, Kite-Gilead, BMS, Al, AstraZeneca and Sobi and grants from Lilly, Tilray and Gr\u00fcnenthal. N Kranzh\u00f6fer received travel grants and other fees from Celgene (Summit, USA), Astra Zeneca (Cambridge, UK), Sandoz (Basel, Schweiz), Janssen Cilag (Neuss, Germany), Beigene (New Jersey, USA), GSK (Philadelphia, USA), Stemline Therapeutics GmbH New York City, USA) M Doerk received travel grants from Gedeon Richter (Budapest, Hungary), Organon (Jersey City, USA) and Eisai (Tokyo, Japan) and is a member of DGGG (Berlin, Germany), AGE (Buchholz, Germany), Deutsche Gesellschaft f\u00fcr Senologie (Berlin, Germany). L Thurner, YJ Kim and A Seibold declare no conflict of interest according to the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Treatment followed standard of care.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Treatment followed the standard of care.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}