{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:13:01Z","timestamp":1787008381684,"version":"build-2736575974"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"21","license":[{"start":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T00:00:00Z","timestamp":1571097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,15]]},"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n The options for immunotherapy treatment are limited for treatment of hepatocellular carcinoma. In this case study, we report a case of successful alternation of one PD-1 inhibitor for another after a hypersensitivity reaction.<\/jats:p>\n <\/jats:sec>\n \n Summary<\/jats:title>\n Nivolumab (Opdivo, Bristol-Myers Squibb) has been Food and Drug Administration (FDA) approved for a variety of malignancies, including a recent approval for hepatocellular carcinoma (HCC). Infusion-related reactions occur in less than 1% of patients, and although such reactions are rare, recognition of infusion-related reactions induced by nivolumab is an important aspect of its usage. The PD-1 checkpoint inhibitor pembrolizumab is also FDA approved for subsequent-line therapy in treatment of HCC. Thus far, approximately 0.2% of patients experienced severe infusion-related reaction in studies using pembrolizumab. A 70-year-old male with HCC had an infusion reaction to nivolumab that presented as facial flushing, dyspnea, and back pain. The patient received prompt administration of diphenhydramine and hydrocortisone, which led to the amelioration of symptoms and allowed the patient to complete his immunotherapy treatment. For the third dose of nivolumab, the patient received premedications prior to treatment, including diphenhydramine, hydrocortisone, and famotidine. During his infusion, the patient experienced facial flushing, coughing, chest tightness, and an itchy throat. The patient again received diphenhydramine and hydrocortisone to treat infusion-related symptoms and his therapy was discontinued. Because of the nivolumab infusion-related reaction, nivolumab was discontinued, and the patient was started on pembrolizumab. The patient tolerated pembrolizumab without any subsequent infusion-related reactions. Prompt recognition and attention to immunotherapy infusion-related reactions could potentially prevent the fatal complication of anaphylaxis with immune checkpoint inhibitors. In this report, we describe the successful transition from one anti\u2013PD-1 therapy to another for continued immunotherapy treatment without any subsequent infusion reactions.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A patient with HCC was successfully treated with pembrolizumab after experiencing adverse effects with nivolumab.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ajhp\/zxz189","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T05:30:45Z","timestamp":1571117445000},"page":"1749-1752","source":"Crossref","is-referenced-by-count":25,"title":["Treatment with pembrolizumab after hypersensitivity reaction to nivolumab in a patient with hepatocellular carcinoma"],"prefix":"10.1093","volume":"76","author":[{"given":"Briana","family":"Choi","sequence":"first","affiliation":[{"name":"University of Arizona College of Pharmacy, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"McBride","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pharmacy, Banner-University of Arizona Cancer Center, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J","family":"Scott","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine, Banner-University of Arizona Cancer Center, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,15]]},"reference":[{"key":"2019101505090327100_CIT0001","article-title":"Nivolumab."},{"key":"2019101505090327100_CIT0002","article-title":"Cancer treatment and chemotherapy.","volume-title":"Pharmacotherapy: a pathophysiologic approach","author":"Shord","edition":"10th"},{"key":"2019101505090327100_CIT0003","article-title":"Pathway-targeted therapies: monoclonal antibodies, protein kinase inhibitors, and various small molecules.","volume-title":"Goodman & Gilman\u2019s: the pharmacological basis of therapeutics","author":"Wellstein","edition":"13th"},{"key":"2019101505090327100_CIT0004","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1016\/S0140-6736(17)31046-2","article-title":"Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase \u00bd dose escalation and expansion trial","volume":"389","author":"El-Khoueiry","year":"2017","journal-title":"Lancet."},{"key":"2019101505090327100_CIT0005","volume-title":"OPDIVO (nivolumab) injection, for intravenous use package insert","year":"2014"},{"key":"2019101505090327100_CIT0006","volume-title":"KEYTRUDA (pembrolizumab) for injection, for intravenous use package insert","year":"2014"},{"key":"2019101505090327100_CIT0007","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/S1470-2045(18)30351-6","article-title":"Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial","volume":"19","author":"Zhu","year":"2018","journal-title":"Lancet Oncol."},{"key":"2019101505090327100_CIT0008","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin Pharmacol Ther."},{"key":"2019101505090327100_CIT0009","author":"National Cancer Institute, National Institutes of Health, US Department of Health and Human Services","year":"2017"},{"key":"2019101505090327100_CIT0010","author":"National Comprehensive Cancer Network"},{"key":"2019101505090327100_CIT0011","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/1759-7714.12494","article-title":"Nivolumab infusion reaction manifesting as plantar erythema and pulmonary infiltrate in a lung cancer patient","volume":"8","author":"Ogawara","year":"2017","journal-title":"Thorac Cancer."}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/76\/21\/1749\/30147503\/zxz189.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/76\/21\/1749\/30147503\/zxz189.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T05:30:48Z","timestamp":1571117448000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/76\/21\/1749\/5587311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,15]]},"references-count":11,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2019,10,15]]},"published-print":{"date-parts":[[2019,10,15]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxz189","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11,1]]},"published":{"date-parts":[[2019,10,15]]}}}