Rationale: Immune-related adverse events have been frequently reported using immune checkpoint inhibitors. However, these reports are commonly observed in single-organ toxicity. Thus, the compound, multiple, multisite, and multi-organ toxicities are seldom recognized and lack treatment experience, finally leading to severe challenges in the clinical treatment of such patients. More case studies are needed to fully understand the diagnostic and treatment strategies formulti-organ immune-related adverse events. This report aims to share the clinical diagnosis and treatment experience of a patient with nasopharyngeal carcinoma who developed severe hepatitis and rash after treatment with toripalimab. Patient concerns: A 57-year-old male farmer was diagnosed with nasopharyngeal carcinoma. Ten days after treatment with the first cycle of terprilizumab combined with gemcitabine and cisplatin, the patient was admitted to the hospital for abnormal liver function tests. Two days after admission, the patient developed another rash. Diagnoses: Based on the patient’s past history, medication history, personal history, and relevant laboratory and imaging examinations, the liver injury and rash for this patient is probable caused by toripalimab. Interventions: The patient received methylprednisolone sodium succinate injection for anti-inflammatory, tiopronin and magnesium isoglycyrrhizate for hepatoprotective, fluticasone propionate cream and cetirizine for anti-allergic. Outcomes: The patient’s hepatitis and rash were effectively controlled after treatment, and no reoccurrence was observed during subsequent antitumor therapy. Lessons: This case proposes that clinician should comprehensively determine the risk of adverse reactions and strengthen medication monitoring to ensure patient safety.

Background: Leptomeningeal metastasis (LM) is a severe complication of advanced non-small-cell lung cancer (NSCLC) that is increasingly detected due to improved diagnostics. Intrathecal therapy, which involves delivering drugs directly into the subarachnoid space, has become a key treatment approach. A variety of cytotoxic drugs, targeted therapies, immune-checkpoint inhibitors, and combination treatments are now available through different intrathecal protocols, offering new hope to patients. Methods: Extensive searches were conducted in PubMed, Embase, the Cochrane Library, Web of Science, Wanfang Data, CNKI, and VIP. Data collected included histological subtype, intrathecal delivery method, treatment regimen, median progression-free survival (mPFS), median overall survival (mOS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) in ≥10% of patients. Results: Twelve clinical studies with 544 patients (average age 53.27 years) met the criteria. Drug delivery was via lumbar puncture or Ommaya reservoir. Objective response rates were 34.5%–86.4%, and disease control rates were 62.5%–94.9%. Three trials reported progression-free survival of 3.5, 6.3, and 9.6 months, with overall survival from 3.66 to 17 months. AEs in over 10% of patients included myelosuppression, gastrointestinal issues, and neurological symptoms. Conclusion: Intrathecal therapy offers significant clinical benefits, especially when combined with other treatments, with a manageable toxicity profile.

Rationale: Patients with bone metastasis-associated cancer pain often experience a complex mix of pain types. Consequently, the use of multimodal combination therapy is essential. While monitoring for common adverse reactions in pain treatment, it is also crucial to be vigilant for the rare but serious serotonin syndrome. Patient concerns: A 53-year-old female with metastatic gastric cancer was hospitalized due to severe, uncontrolled thoracic and cervical pain. During the titration of her cancer pain medication, she developed serotonin syndrome. Diagnoses: He was diagnosed with refractory cancer pain and serotonin syndrome. Interventions: The complete process of cancer pain medication in a patient with gastric cancer and bone metastasis was analyzed, with a primary focus on the selection of analgesic medications, adjustment of opioid dosages, and prevention and treatment of medication-associated adverse reactions. Outcomes: The patient’s cancer pain was well controlled, with the prompt management of adverse reactions. Furthermore, by adjusting the medication regimen, intolerable adverse reactions were prevented. Lessons: In clinical settings, personalized analgesic regimens must be developed for patients with cancer pain to enhance patient compliance with medication, prevent the occurrence of severe adverse reactions, and improve the overall quality of life of patients with cancer. Healthcare professionals should pay increased attention to ADRs associated with opioid medications, whereas pharmacists should assist them in promptly identifying ADRs.

Immune checkpoint inhibitor (ICI) offer hope for patients with advanced non-small cell lung cancer; however, there is no consensus on the optimal course of