Table 2 Timeline of progression of acral necrosis since administration of PD-1 inhibitor
Timeline from Treatment | Clinical Progression |
|---|---|
Day 0 | 1st dose of pembrolizumab (No symptoms) |
At 25 weeks | Raynaud’s like symptoms (Patient started on nifedipine) |
At 27 weeks | No resolution of Raynaud’s symptoms and persistence of cyanosis (Patient started on prednisone) |
At 29 weeks | Development of dry gangrene at fingertips bilaterally |
At 33 weeks | Extension of necrosis and development of ulceration. Patient still on pembrolizumab. Sympathectomy performed (patient still on nifedipine and glucocorticoids) |
At 37 weeks | Tumor progression (pembrolizumab stopped). Extension of the necrosis stopped after week 37 |