Severe blood-clotting disorder, liver injury, and reversible kidney injury during treatment for Stage IV lung cancer

What happened, in summary

A 63-year-old man was found to have a right lower-lung mass during evaluation for urinary retention in September 2025. Later imaging showed that the cancer had spread beyond the lung, including to the ribs. Biopsy confirmed lung adenocarcinoma, and the disease was Stage IV. Testing showed PD-L1 at about 1% and a KRAS mutation.

Treatment began in December 2025 with ivonescimab plus nab-paclitaxel and cisplatin. He received 3 cycles that included ivonescimab. Scans before cycle 4 showed a partial response, and the fourth cycle used chemotherapy alone.

About 10 days later, he developed fever followed by rapidly worsening kidney function, jaundice, and dark urine. His condition became severe enough to require intensive kidney support. Blood tests then confirmed a rare immune-related blood-clotting disorder known as iTTP. He also developed significant liver injury.

Ivonescimab was permanently stopped. He received intensive treatment for the complications, including steroids, plasma exchange, kidney support, and rituximab. His kidney function recovered and the liver injury improved. Cancer treatment remained interrupted while these serious complications were managed.