CASE REPORT article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicCancer Therapy Related Organ ToxicitiesView all 16 articles
Accelerated Parathyroid Adenoma Progression and Hypercalcemia-Driven Neurotoxicity Following Pembrolizumab-Based Neoadjuvant Therapy in Triple-Negative Breast Canc er: A Case of Multisystem Immune-Related Adverse Events
Provisionally accepted
- Huizhou Third Peoole's Hospital, Huizhou, China
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This case report describes a 45-year-old TNBC patient (cT3N1M0 IIIA) with preexisting p -arathyroid adenoma who developed multi-system immune-related toxicities after neoadjuvan -t pembrolizumab chemotherapy. Post-2 cycles, severe hepatotoxicity (ALT 1090 U/L), grad -e 2 dermatitis, hypercalcemic crisis (iPTH 61.99 pmol/L), and meningeal thickening with intracranial hypertension emerged. Imaging revealed 134% parathyroid adenoma enlargemen -t and diffuse meningeal enhancement. Emergency parathyroidectomy and corticosteroids no -rmalized calcium and reversed neurological symptoms. Pathological complete response (pC -R) occurred despite ICI discontinuation. This first-reported case suggests PD-1 inhibitors may activate parathyroid microenvironments to drive adenoma growth. At the same time, c -alcium-ICI synergy could impair blood-brain barrier integrity, advocating calcium/neurologi -cal monitoring in ICI-treated endocrine disorder patients.
Keywords: breast cancer, Pembrolizumab, Parathyroid adenoma, Hypercalcemia, immune-related adverse
Received: 08 Apr 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 Zeng, Sun and Qian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yu Sun, 15089231312@163.com
Pengfei Qian, 568156441@qq.com
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