A case report involving suppressed nuclear receptor transcription factors 4a1 and Stevens-Johnson syndrome induced by a single dose of pembrolizumab and successfully treated with early steroid administration, resulting in complete remission of stage III lung cancer

Table 1 Simple regression analysis of the pembrolizumab level and the immune responsive indices, such as blood levels of pembrolizumab, cytokines and target mRNAs for IL-23 receptor (IL-23R), Foxp3, RORγt, Lag3 and Runx3

Dependent variables	Independent variables	Unstandardized coefficient	df	R²	F	P values
IL-17	IFN-γ	2.56	1, 8	0.50	6.9	0.034^*
	IL-6	-2.27	1, 8	0.01	0.1	0.822
	IL-10	-12.20	1, 8	0.54	8.1	0.025^*
	IL-23	-0.07	1, 8	0.01	0.1	0.785
	IL-27	0.65	1, 8	0.06	10.7	0.527
	IL-23R mRNA	41.57	1, 8	0.56	8.9	0.020^*
	RORγt mRNA	-0.66	1, 8	0.00	0.0	0.991
	Foxp3 mRNA	66.92	1, 8	0.17	1.5	0.264
	Pembrolizumab	8.30	1, 8	0.78	20.9	0.004^**
IFN-γ	IL-23	-0.07	1, 8	0.12	1.0	0.355
	IL-27	0.12	1, 8	0.03	0.2	0.686
	Runx3 mRNA	38.55	1, 8	0.60	10.3	0.015^*
	Lag3 mRNA	-4.75	1, 8	0.01	0.1	0.769
	Pembrolizumab	2.30	1, 8	0.77	20.6	0.004^**
IL-10	IFN-γ	-0.11	1, 8	0.26	2.5	0.159
	IL-17	-0.04	1, 8	0.54	8.2	0.025^*
	IL-27	0.06	1, 8	0.16	1.3	0.285
	Foxp3 mRNA	0.06	1, 8	0.00	0.0	0.986
	Lag3 mRNA	0.01	1, 8	0.53	7.8	0.027^*
	Pembrolizumab	-0.35	1, 8	0.40	4.0	0.094
Foxp3 mRNA	Runx3 mRNA	0.51	1, 8	0.23	2.0	0.197
Foxp3 mRNA	Pembrolizumab	0.01	1, 8	0.01	0.1	0.807
Lag3 mRNA	IL-27	0.03	1, 8	0.53	7.8	0.027^*
Lag3 mRNA	Pembrolizumab	-0.016	1, 8	0.08	0.5	0.496
RORγt mRNA	IL-6	-0.04	1, 8	0.06	0.4	0.565
	Foxp3 mRNA	0.59	1, 8	0.32	3.3	0.112
	Pembrolizumab	0.00	1, 8	0.01	0.0	0.870
IL-23R mRNA	Pembrolizumab	0.08	1, 8	0.25	2.0	0.204
Runx3 mRNA	Pembrolizumab	0.04	1, 8	0.84	30.5	0.002^**
NLR	IL-10	-0.28	1, 8	0.71	17.1	0.004^**
PLR	RORγt mRNA	-122.7	1, 8	0.58	9.8	0.017^*

Plasma concentrations of pembrolizumab and cytokines, such as major IL-17, IFN-γ, IL-10, and those upstream of IL-6, IL-23 and IL-27, were evaluated by ELISA methods. Target mRNAs were evaluated by RT‒qPCR methods with total RNA extracted from peripheral blood mononuclear cells. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were used as predictive factors for serious immune-related adverse events. Regarding these factors, only the indices extracted as a significant independent variable for these factors are presented. *p < 0.05, **P < 0.001

ISSN: 2055-0294