A case of large-cell lung carcinoma successfully treated with pembrolizumab but complicated with cholangitis

Ooi, Ryunosuke; Tobino, Kazunori; Sakabe, Mitsukuni; Kawabata, Takafumi; Hiramatsu, Yuri; Sueyasu, Takuto; Yoshimine, Kohei

doi:10.1016/j.rmcr.2020.101197

Cited by 9 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the basis of real-world experience of IMH from the UK, prednisolone higher than 60 mg/day has not demonstrated any additional benefit regarding time to hepatitis resolution [28]. Therefore, if no inflammation remains in a repeated biopsy, tapering of GC is recommended [58].…”

Section: Discussionmentioning

confidence: 99%

Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management

Pi¹,

Wang²,

Tong

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

View full text Add to dashboard Cite

Background & Aims Immune checkpoint inhibitors (ICIs) improve the survival of patients with advanced tumors. However, immune-related adverse events limit the use of ICIs. Although liver toxicity has been concerned gradually, little is known about bile duct injury associated with ICIs. Hence, this review aims to describe clinicopathological features, imaging, and management of immune-mediated cholangitis (IMC) induced by ICIs. Methods We retrieved the literature from the PubMed database for case reports and series of IMC induced by ICIs. IMC was then classified as small-ducts type, large-ducts type and mixed type. Biochemical parameters, pathological characteristics, imaging features, treatment and response were evaluated and compared among three patterns. Results Fifty-three cases of IMC were enrolled. The median values of alkaline phosphatase and alanine transaminase of IMC were 1328 and 156 IU/L. The ALP level of the large-ducts type was higher than that of the small-ducts type (P = 0.021). The main pathological characteristics of small-ducts cholangitis were portal inflammation, bile duct injury and ductular reaction. The imaging features of large-duct cholangitis were bile duct dilatation, stenosis and bile duct wall thickening and irregularity. Forty-eight (90%) cases received immunosuppression therapy. Biliary enzymes reduced in 79% of cases receiving immunosuppression therapy, but only 8.5% of cases returned to normal. It took a long time for biliary enzymes to recover. Conclusions The clinicians should be aware of the possibility of IMC if the biliary enzymes increase significantly after the use of ICIs. The liver function can be improved partially by immunosuppressive therapy in the majority of IMC.

show abstract

Section: Discussionmentioning

confidence: 99%

Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management

Pi¹,

Wang²,

Tong

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

View full text Add to dashboard Cite

show abstract

“…ICIs targeting PD‐L1 have been shown to be effective against multiple cancer types, including NSCLC 4 . Recently, there have been reports that ICI treatment is effective against rare histological types of NSCLC where PD‐L1 is highly expressed 6–8 . This case report suggests the possibility of a new treatment strategy for LCC, which is generally thought to have a poor prognosis.…”

Section: Discussionmentioning

confidence: 81%

“…The results of the KEYNOTE‐024 trial and KEYNOTE‐042 trials showed that pembrolizumab, a monoclonal antibody against PD‐1, was more effective than conventional platinum‐based combination chemotherapy as a first‐line treatment for advanced NSCLC expressing PD‐L1 on the tumor cells, which are negative for epidermal growth factor receptor gene (EGFR) mutation and anaplastic lymphoma kinase gene ( ALK ) rearrangement 4,5 . Furthermore, PD‐L1 inhibitors have been reported to be effective in rare classifications of NSCLC, such as LCC and pleomorphic carcinoma 6–8 …”

Section: Discussionmentioning

confidence: 99%

Pulmonary large cell carcinoma, highly positive for PD‐L1, shows marked response to pembrolizumab: A case report

et al. 2021

View full text Add to dashboard Cite

Pulmonary large cell carcinoma (LCC) is classified as a poorly defined entity among non‐small cell lung cancers (NSCLCs). At present, there are no effective anticancer drugs, such as molecular targeted drugs, for LCC, and it has been reported that patient prognosis is poor. Recently, the development of immune checkpoint inhibitors (ICIs) has changed the therapeutic strategies for patients with NSCLC. Here, we present a case of LCC successfully treated with pembrolizumab. A 58‐year‐old man who was a former smoker was diagnosed with LCC. The postoperative stage was T3N2M0. During postoperative adjuvant chemotherapy, swelling of the supraclavicular lymph node was observed and the patient was diagnosed with recurrence. The patient was treated with two regimens of conventional cytotoxic chemotherapy; however, he experienced some hoarseness. Imaging confirmed swelling of the hilar and mediastinal lymph nodes and the patient was subsequently diagnosed with disease progression. Previous surgical specimens when immunostained showed that a high proportion of the tumor cells were positive for expression of programmed death‐ligand 1 (PD‐L1), and it was decided to commence treatment with pembrolizumab. This treatment resulted in rapid regression of the hilar and mediastinal lymph nodes, and a progression‐free period maintained for at least 24 treatment cycles. The patient's hoarseness improved, and the lymph nodes decreased in size. Immunotherapy targeting PD‐1/PD‐L1 may be an option for patients with PD‐L1 positive LCC. This case report suggests that treatment with ICIs may be important in the selection of treatment for not only LCC but also relatively rare NSCLC with high PD‐L1 expression.

show abstract

“…However, in the case reported by Ooi R et al., after the initial 1 mg/kg/day PSL treatment, IRH recurred during steroid reduction, and AZA was ineffective, although in this case after three days of pulse treatment with 1000 mg mPSL, "So-called" steroid-refractory IRH was successfully treated. This patient remained free of recurrence of the primary disease one year after ICI withdrawal as well [51] . The above case suggests that it is necessary to consider the use of steroid pulse therapy before diagnosing steroid-refractory IRH, and the steroid pulse therapy may not affect the prognosis of patients with tumor treatment.…”

Section: Steroid Refractoriness or Dose Of Steroid Is Not Enough?mentioning

confidence: 76%

The Current status of steroid-refractory immune-checkpoint-inhibitor-related hepatotoxicity

Xing

Wang

Wei

et al. 2023

Translational Oncology

View full text Add to dashboard Cite

A case of large-cell lung carcinoma successfully treated with pembrolizumab but complicated with cholangitis

Cited by 9 publications

References 23 publications

Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management

Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management

Pulmonary large cell carcinoma, highly positive for PD‐L1, shows marked response to pembrolizumab: A case report

The Current status of steroid-refractory immune-checkpoint-inhibitor-related hepatotoxicity

Contact Info

Product

Resources

About