Late onset of nivolumab-induced severe gastroduodenitis and cholangitis in a patient with stage IV melanoma

Cǎlugǎreanu, Andreea; Rompteaux, Pierre; Bohelay, G.; Goldfarb, Lucas; Barrau, Vincent; Cucherousset, Nahla; Heidelberger, Valentine; Nault, Jean‐Charles; Ziol, Marianne; Caux, F.; Maubec, E.

doi:10.2217/imt-2019-0077

Cited by 23 publications

(15 citation statements)

References 19 publications

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“…However, the exact frequency of gastritis caused by ICI is unknown because there have been only 17 reports to date, including the present case [3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

Saito

Ozono

Nagumo

et al. 2022

Clin J Gastroenterol

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A 71-year-old Japanese man was treated with 200 mg of pembrolizumab for lung adenocarcinoma with multiple bone metastases at the Department of Respiratory Medicine of Kameda General Hospital. After 19 treatment courses, he complained of epigastric pain before meals. Upper gastrointestinal endoscopy showed multiple erosions in the gastric antrum, and antacids were administered at follow-up. After 27 treatment courses, the patient underwent another endoscopy because of anorexia. The erosions were enlarged and had increased from the gastric antrum to the greater curvature of the body. Histological biopsy showed lymphocytic infiltration with a predominance of CD8-positive T cells. The patient had previously been treated for Helicobacter pylori infection, and we suspected drug-induced gastritis due to the administration of immune checkpoint inhibitors in the course of the disease. Pembrolizumab was discontinued, and the patient’s symptoms gradually improved. Endoscopic examinations were performed 2, 5, and 9 months after discontinuation of pembrolizumab, and improvement in mucosal findings and decreased lymphocyte infiltration were confirmed each time. The patient has remained without any relapse of symptoms for more than 1 year after discontinuing treatment.

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Section: Discussionmentioning

confidence: 99%

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

Saito

Ozono

Nagumo

et al. 2022

Clin J Gastroenterol

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“…The gastric symptoms responded well to corticosteroids, but for cholangitis, an immune-suppression intensification with mycophenolate mofetil or anti-TNF was considered. Still, the treatment was not initiated because of a systemic infection with Staphylococcus aureus [33].…”

Section: Discussionmentioning

confidence: 99%

“…Celiac disease has been reported as a rare event; incidence of 0.05% after ICI treatment, most of cases with good symptom resolution after dietary changes [32]. Another peculiar case, of late onset asymptomatic gastro-duodenitis associated with cholangitis, with good response to corticosteroids was described in a melanoma patient following nivolumab therapy [33].…”

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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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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“…The remaining 8 patients with colitis symptoms and negative PET-CT did not have diarrhea at the time PET-CTs were performed. Two separate case reports describe instances of gastroduodenitis and esophagitis/gastritis in patients receiving ICPIs, where FDG PET-CT detected enhanced FDG uptake within the affected organs [20, 21].…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography as an adjuvant diagnostic test in the evaluation of checkpoint inhibitor-associated acute interstitial nephritis

Qualls

Seethapathy

Bates

et al. 2019

j. immunotherapy cancer

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BackgroundAcute interstitial nephritis is an immune-related adverse event that can occur in patients receiving immune checkpoint inhibitor therapy. Differentiating checkpoint inhibitor-associated acute interstitial nephritis from other causes of acute kidney injury in patients with cancer is challenging and can lead to diagnostic delays and/or unwarranted immunosuppression. In this case report, we assess the use of 18F-flourodeoxyglucose positron-emission tomography imaging as an alternative diagnostic modality in the evaluation of potential acute interstitial nephritis.Case presentationA 55-year-old woman with metastatic vulvar melanoma underwent treatment with two cycles of ipilimumab plus nivolumab, followed by seven cycles of nivolumab combined with radiation therapy. During her treatment, she developed non-oliguric acute kidney injury to a creatinine of 4.5 mg/dL from a baseline of 0.5 mg/dL. A clinical diagnosis of acute interstitial nephritis was made, and steroids were initiated, with rapid improvement of her acute kidney injury. Retrospectively, four positron-emission tomography scans obtained for cancer staging purposes were reviewed. We found a markedly increased 18F-flourodeoxyglucose uptake in the renal cortex at the time acute interstitial nephritis was diagnosed compared to baseline. In three cases of acute kidney injury due to alternative causes there was no increase in 18F-flourodeoxyglucose uptake from baseline.ConclusionsTo our knowledge, this is the first report describing increased 18F-flourodeoxyglucose uptake in the renal cortex in a patient with checkpoint inhibitor-associated acute interstitial nephritis. Our findings suggest that 18F-flourodeoxyglucose positron-emission tomography may be a valuable test for diagnosing immune-mediated nephritis, particularly in patients where timely kidney biopsy is not feasible.

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Late onset of nivolumab-induced severe gastroduodenitis and cholangitis in a patient with stage IV melanoma

Cited by 23 publications

References 19 publications

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

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

Positron emission tomography as an adjuvant diagnostic test in the evaluation of checkpoint inhibitor-associated acute interstitial nephritis

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