Fatal hemoptysis despite complete remission of squamous cell carcinoma after chemoradiotherapy followed by combined ipilimumab and nivolumab: An autopsy case report

In patients receiving ipilimumab and nivolumab after thoracic CRT for centrally located squamous cell carcinoma, rapid tumor necrosis and cavitation within irradiated lung with fragile vasculature may markedly increase the risk of severe and fatal hemoptysis. When initiating or resuming combined immune checkpoint inhibitor therapy in this setting, clinicians should carefully consider CRT-associated vascular fragility and potential immune-mediated vascular injury, and ensure close imaging follow-up and airway surveillance.