ArticleFrontiers in oncology2025
Case Report: Accelerated parathyroid adenoma progression and hypercalcemia-driven neurotoxicity following pembrolizumab-based neoadjuvant therapy in triple-negative breast cancer: a case of multisystem immune-related adverse events.
Article in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This case report describes a 45-year-old TNBC patient (cT3N1M0 IIIA) with preexisting parathyroid adenoma who developed multisystem immune-related toxicities after neoadjuvant pembrolizumab chemotherapy. After two cycles, severe hepatotoxicity (ALT 1,090 U/L), grade 2 dermatitis, hypercalcemic crisis (iPTH 61.99 pmol/L), and meningeal thickening with intracranial hypertension emerged. Imaging revealed 134% parathyroid adenoma enlargement and diffuse meningeal enhancement. Emergency parathyroidectomy and corticosteroids normalized calcium and reversed neurological symptoms. Pathological complete response (pCR) occurred despite ICI discontinuation. This first-reported case suggests that PD-1 inhibitors may activate parathyroid microenvironments to drive adenoma growth. At the same time, calcium-ICI synergy could impair blood-brain barrier integrity, advocating calcium/neurological monitoring in ICI-treated endocrine disorder patients.
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