Case of small bowel perforation secondary to nivolumab and ipilimumab related tumour regression

Patel, Kishen R; L, Lee; Tripathy, Arvind; McKean, David

doi:10.1136/bcr-2019-232304

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…The case revealed the large spectrum of immune-related adverse effects that can even be missed or diagnosed by chance [45]. Another interesting side effect involving the small bowel was reported in a 56-year-old patient with metastatic melanoma, under treatment with nivolumab and ipilimumab, who developed small bowel perforation due to fast tumor regression after immunotherapy, revealing the multitude of possibilities when it comes to ICI related adverse effects [46]. We found other four cases of nivolumab, ipilimumab or atezolizumab treated patients that developed small bowel perforation due to ICI treatment that were also reported in the literature [47][48][49][50].…”

Section: Discussionmentioning

confidence: 92%

“…A case of asymptomatic appendicitis after dual therapy (nivolumab and ipilimumab) therapy [45] diagnosed through a routine positron emission tomography (PET) pointed out the specter of immune related events that can be missed or only diagnosed by chance; another interesting case described a small bowel perforation due to fast tumor regression secondary to nivolumab and ipilimumab treatment [46]. Other four cases of patients under nivolumab, ipilimumab or atezolizumab therapy developed small bowel perforation, a rare, but potentially fatal event [47][48][49][50].…”

Section: Gastrointestinal Tract Toxicitymentioning

confidence: 99%

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Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Radulescu

Crişan

Grapa

et al. 2021

JGLD

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Background and Aims: While immune checkpoint inhibitors therapy (ICI) is exceedingly effective, these drugs are associated with various immune-related adverse effects. As gastrointestinal, hepatic or pancreatic toxicity becomes more common, various reports of rare adverse effects have emerged, leading to a significant clinical and prognostic impact. We aimed to provide a systematic review of mainly case-reports on rare events, to help physicians to make an accurate and fast diagnosis. Methods: We performed a systematic review of the literature, using established MeSH terms: “immune checkpoint inhibitors”, “gastrointestinal tract”, “gastrointestinal diseases”, “liver”, “pancreas”, “nivolumab”, “ipilimumab”, the subheadings “adverse effects”, “toxicity” and the supplementary concepts “pembrolizumab”, “tremelimumab”, “atezolizumab”, “avelumab”, “durvalumab”, with defined inclusion criteria. Results: From 419 manuscripts initially selected, 74 reports of rare adverse events were included in our review. Special cases of neutrophilic gastritis, hemorrhagic gastritis, or even perforations were described at upper digestive tract. Different types of colitis were found secondary to ICI such as pseudomembranous, granulomatous, collagenous and microscopic colitis or even inflammatory bowel disease. In terms of liver toxicity, we found rare reports of cholangitis, granulomatous hepatitis, lipodystrophy and hepatic sinusoidal obstruction syndrome. Pancreas toxicity was rarely reported as severe pancreatitis, exocrine failure and diabetes mellitus. Conclusion: Although a complete check-up of every organ at every routine visit may not be practical, focus on symptoms, targeted laboratory and imaging testing may reveal rare organ damage. Raising awareness of the uncommon toxicities related to the immunotherapy is essential, as some rare events can lead to fatal outcomes.

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Section: Discussionmentioning

confidence: 92%

Section: Gastrointestinal Tract Toxicitymentioning

confidence: 99%

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Radulescu

Crişan

Grapa

et al. 2021

JGLD

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“…Enterocolitis associated with immunotherapy has an incidence of 2.0%[ 28 ], which increases to 40.0% in patients on ipilimumab[ 29 ], and usually develops after 6-7 wk of treatment. Bowel perforation and death occur respectively in 1.0% and 0.8% of patients[ 27 - 31 ].…”

Section: Enterocolitismentioning

confidence: 99%

“…Intestinal perforation after immunotherapy is a rare event (Figure 6 ). A case report by Patel et al [ 31 ] described a jejunal perforation after treatment with ipilimumab and nivolumab for metastatic melanoma, related to tumor regression. Another paper by Romano et al [ 65 ] reported a small bowel perforation in a patient treated with nivolumab for metastatic lung cancer.Radiofrequency or micro-wave ablation can cause injuries to nearby organs.…”

Section: Perforationmentioning

confidence: 99%

Surgical complications of oncological treatments: A narrative review

Fico¹,

Altieri²,

Grezia³

et al. 2023

World J Gastrointest Surg

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Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

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“…A similar phenomenon (of rupture associated with vemurafenib treatment) can occur in the case of the liver [ 135 ]. The rare possibility of immunotherapy causing non-inflammatory bowel perforations as a result of rapid tumor regression, is an important aspect of the medical literature [ 136 , 137 ], as the toxicity of immune checkpoint inhibitors like ipilimumab and nivolumab is related to their clinical efficacy. Adjuvant high-dose ipilimumab administered after ipilimumab and nivolumab for inoperable metastatic disease [ 138 ] were also reported.…”

Section: Main Findings Of the Literature (Review) Questmentioning

confidence: 99%

Intra-Abdominal Malignant Melanoma: Challenging Aspects of Epidemiology, Clinical and Paraclinical Diagnosis and Optimal Treatment—A Literature Review

et al. 2022

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According to European consensus-based interdisciplinary guidelines for melanoma, cutaneous melanoma (CM) is the most deadly form of dermatological malignancy, accounting for 90% of the deaths of skin cancer patients. In addition to cutaneous melanoma, mucosal melanoma occurs in four major anatomical sites, including the upper respiratory tract, the conjunctiva, the anorectal region, and the urogenital area. As this cancer type metastasizes, a classification used in the current medical literature is the distinction between secondary lesions and primary malignant melanoma of the abdominal cavity. Given that malignant melanoma is the most common cancer that spreads to the gastrointestinal tract, different imaging modalities compete to diagnose the phenomenon correctly and to measure its extension. Treatment is primarily surgery-based, supported by immunotherapy, and prolongs survival, even when performed at stage IV illness. In the end, special forms of malignant melanoma are discussed, such as melanoma of the genito-urinary tract and amelanotic/achromic melanoma. The importance of this present literature review relies on yielding and grouping consistent and relevant, updated information on the many aspects and challenges that a clinician might encounter during the diagnosis and treatment of a patient with intra-abdominal melanoma.

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Case of small bowel perforation secondary to nivolumab and ipilimumab related tumour regression

Cited by 5 publications

References 8 publications

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Surgical complications of oncological treatments: A narrative review

Intra-Abdominal Malignant Melanoma: Challenging Aspects of Epidemiology, Clinical and Paraclinical Diagnosis and Optimal Treatment—A Literature Review

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