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A case of severe immune-related ulcerative colitis caused by pembrolizumab

Published on Nov. 30, 2023Total Views: 584 times Total Downloads: 260 times Download Mobile

Author: Jin-Jin ZOU Ji-Liang ZHANG Ni LI Ding-Yi LIU

Affiliation: Department of Oncology, Chengdu Seventh People's Hospital/ Affiliated Cancer Hospital of Chengdu Medical College, Chengdu 610041, China

Keywords: Pembrolizumab Lung squamous cell carcinoma Severe immune-related ulcerative colitis Adverse drug reactions

DOI: 10.19960/j.issn.1005-0698.202311015

Reference: Jin-Jin ZOU, Ji-Liang ZHANG, Ni LI, Ding-Yi LIU.A case of severe immune-related ulcerative colitis caused by pembrolizumab[J].Yaowu Liuxingbingxue Zazhi,2023, 32(11):1311-1315.DOI: 10.19960/j.issn.1005-0698.202311015.[Article in Chinese]

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Abstract

A 57-year-old male patient with advanced lung squamous cell carcinoma developed severe diarrhea, abdominal pain and bloody stool after receiving 5 cycles of pembrolizumab combined chemotherapy and 1 cycle of single drug pembrolizumab combined with the results of colonoscopy and histopathology, it was diagnosed as colitis, which was considered as severe immune related ulcerative colitis caused by pembrolizumab. After suspending immunotherapy and receiving sufficient glucocorticoid treatment, the patient's abdominal pain and diarrhea significantly improved 2 days later, and relieved 15 days later. In order to improve the safety of the clinical application of pembrolizumab, risk factors, clinical characteristics and treatment of immune associated colitis induced by pembrolizumab were further analyzed by reviewing the literature of the adverse reactions related to it.

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References

1.周彩存, 王洁, 王宝成, 等. 中国非小细胞肺癌免疫检查点抑制剂治疗专家共识(2020年版)[J]. 中国肺癌杂志, 2021, 24(4): 217-235. [Zhou CC, Wang J, Wang BC, et al. Chinese experts consensus on immune checkpoint inhibitors for Non-small Cell Lung Cancer (2020 Version) [J]. Chinese Journal of Lung Cancer, 2021, 24(4):217-235.] DOI: 10.3779/j.issn.1009-3419.2021.101.13.

2.Hamid O, Robert C, Daud A, et al. Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001[J]. Ann Oncol, 2019, 30(4): 582-588. DOI: 10.1093/annonc/mdz011.

3.Shieh AC, Guler E, Pfau D, et al. Imaging and clinical manifestations of immune checkpoint inhibitor-related colitis in cancer patients treated with monotherapy or combination therapy[J]. Abdom Radiol (NY), 2020, 45(10): 3028-3035. DOI: 10.1007/s00261-019-02334-3.

4.Anstadt EJ, Chu B, Yegya-Raman N, et al. Moderate colitis not requiring intravenous steroids is associated with improved survival in stage IV melanoma after anti-CTLA4 monotherapy, but not combination therapy[J]. Oncologist, 2022, 27(9): 799-808. DOI: 10.1093/oncolo/oyac108.

5.Ohwada S, Ishigami K, Akutsu N, et al. Pharmacological treatments available for immune-checkpoint-inhibitor-induced colitis[J]. Biomedicines, 2022,10(6). DOI: 10.3390/biomedicines10061334.

6.Herbst RS, Garon EB, Kim DW, et al. Long-term outcomes and retreatment among patients with previously treated, programmed death-ligand 1-positive, advanced Non-Small-Cell Lung Cancer in the KEYNOTE-010 study[J]. J Clin Oncol, 2020, 38(14): 1580-1590. DOI: 10.1200/JCO.19.02446.

7.国家药品不良反应监测中心. 药品不良反应术语使用指南(征求意见稿)[S]. 2016.

8.Collins M, Soularue E, Marthey L, et al. Management of patients with immune checkpoint inhibitor-induced enterocolitis: a systematic review[J]. Clin Gastroenterol Hepatol, 2020, 18(6): 1393-1403. DOI: 10.1016/j.cgh.2020.01.033.

9.De Velasco G, Je Y, Bosse D, et al. Comprehensive meta-analysis of key immune-related adverse events from CTLA-4 and PD-1/PD-L1 inhibitors in cancer patients[J]. Cancer Immunol Res, 2017, 5(4): 312-318. DOI: 10.1158/2326-6066.CIR-16-0237.

10.Tandon P, Bourassa-Blanchette S, Bishay K, et al. The risk of diarrhea and colitis in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis[J]. J Immunother, 2018, 41(3): 101-108. DOI: 10.1097/CJI.0000000000000213.

11.Zhang B, Wu Q, Zhou YL, et al. Immune-related adverse events from combination immunotherapy in cancer patients: a comprehensive meta-analysis of randomized controlled trials[J]. Int Immunopharmacol, 2018, 63: 292-298. DOI: 10.1016/j.intimp.2018.08.014.

12.Wang DY, Mooradian MJ, Kim D, et al. Clinical characterization of colitis arising from anti-PD-1 based therapy[J]. OncoImmunology, 2018, 8(1): e1524695. DOI: 10.1080/2162402X.2018.1524695.

13.Marthey L, Mateus C, Mussini C, et al. Cancer immunotherapy with anti-CTLA-4 monoclonal antibodies induces an inflammatory bowel disease[J]. J Crohns Colitis, 2016, 10(4): 395-401. DOI: 10.1093/ ecco-jcc/jjv227.

14.Chaput N, Lepage P, Coutzac C, et al. Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab[J]. Ann Oncol, 2019, 30(12): 2012. DOI: 10.1093/annonc/mdz224.

15.Friedlander P, Wood K, Wassmann K, et al. A whole-blood RNA transcript-based gene signature is associated with the development of CTLA-4 blockade-related diarrhea in patients with advanced melanoma treated with the checkpoint inhibitor tremelimumab[J]. J Immunother Cancer, 2018, 6(1): 90. DOI: 10.1186/s40425-018-0408-9.

16.中国临床肿瘤学会指南工作委员会. 免疫检查点抑制剂相关的毒性管理指南(2021 版)[M]. 北京: 人民卫生出版社, 2021: 60-63.

17.Thompson JA, Schneider BJ, Brahmer J, et al. NCCN guidelines insights: management of immunotherapy-related toxicities, version 1.2020[J]. J Natl Compr Canc Netw, 2020, 18(3): 230-241. DOI: 10.6004/jnccn.2020.0012.

18.Thompson JA, Schneider BJ, Brahmer J, et al. Management of immunotherapy-related toxicities, version 1.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(4): 387-405. DOI: 10.6004/jnccn.2022.0020.

19.Abu-Sbeih H, Ali FS, Alsaadi D, et al. Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: a multi-center study[J]. J Immunother Cancer, 2018, 6(1): 142. DOI: 10.1186/s40425-018-0461-4.

20.Wang Y, Wiesnoski DH, Helmink BA, et al. Fecal microbiota transplantation for refractory immune checkpoint inhibitor-associated colitis[J]. Nat Med, 2018, 24(12): 1804-1808. DOI: 10.1038/s41591-018-0238-9.

21.Thompson JA, Schneider BJ, Brahmer J, et al. Management of immunotherapy-related toxicities, version 1.2019[J]. J Natl Compr Canc Netw, 2019, 17(3): 255-289. DOI: 10.6004/jnccn.2019.0013.

22.Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade[J]. N Engl J Med, 2018, 378(2): 158-168. DOI: 10.1056/NEJMra1703481.

23.Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2022, 33(12): 1217-1238. DOI: 10.1016/j.annonc.2022.10.001.

24.柏愚, 李延青, 任旭, 等. 应激性溃疡防治专家建议(2018版)[J]. 中华医学杂志, 2018, 98(42): 3392-3395. [Bai Y, Li YQ, Ren X, et al. Expert suggestions on prevention and treatment of irritability ulcer (2018 Edition) [J]. National Medical Journal of China, 2018, 98(42): 3392-3395.] DOI: 10.3760/cma.j.issn.0376-2491.2018.42.003.

25.Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update[J]. J Clin Oncol, 2021, 39(36): 4073-4126. DOI: 10.1200/JCO.21.01440.

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