Pembrolizumab-induced large duct cholangiopathy

Chatterjee, Aparna; Bivas, B K; Gehani, Anisha; Sen, Sudipta

doi:10.4103/jpgm.jpgm_793_20

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…15 Large duct changes were reported in association with pembrolizumab and nivolumab. 16,17 One study found radiological features of cholangiopathy in two patients treated with pembrolizumab, with a third demonstrating primary biliary cholangitis-like changes histologically. 18 Other biliary features have included noninfective cholangitis with predominant neutrophilic or lymphocytic infiltrates.…”

Section: Introductionmentioning

confidence: 99%

“…Doherty et al reported three cases of severe liver injury associated with biliary changes that were refractory to therapy, including a ‘disappearing bile duct’ phenotype 15 . Large duct changes were reported in association with pembrolizumab and nivolumab 16,17 . One study found radiological features of cholangiopathy in two patients treated with pembrolizumab, with a third demonstrating primary biliary cholangitis‐like changes histologically 18 .…”

Section: Introductionmentioning

confidence: 99%

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Immune checkpoint inhibitor‐related cholangiopathy: Novel clinicopathological description of a multi‐centre cohort

Berry

Kotha

Zen

et al. 2022

Liver International

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Background and aims: Cholestatic liver dysfunction is common in immune-related hepatitis (irH) during treatment with immune checkpoint inhibitors (CPI) for malignancy. We investigated the spectrum of bile duct injury and associated natural history in this cohort.Method: Clinical, laboratory, radiological and histopathological data in patients with evidence of bile duct injury during CPI treatment from 2018 to 2020 was collected in three tertiary hospitals.Results: In this study, ten patients with confirmed bile duct disease were identified.Pembrolizumab was most commonly implicated (8/10). Median CPI cycles prior to bile duct injury was 6. Median alanine aminotransferase and alkaline phosphatase were 225 U/L and 1549 U/L respectively. Clinical jaundice was seen in 6/10 and radiological evidence of bile duct pathology in 8/10. Of five patients, who had liver biopsy, three cases (including two cases with normal MRCP) showed primary sclerosing cholangitis (PSC) like changes with periductal fibrosis. All patients were treated first-line with prednisolone following cessation of CPI, three with mycophenolate mofetil and one with tacrolimus, with clinical response in four patients. Five patients died after a mean follow-up of 27 weeks; cause of death was primarily related to progression of malignancy. Conclusion:Within this heterogeneous cohort, we identified that CPI-related cholangiopathy responded poorly to immunosuppression and potentially progressed to bile duct loss. Thorough radiological and histological assessment is recommended, as identification of the cholangiopathy-associated phenotype may permit more informed advice regarding prognosis. Further data is required to determine detailed immunological characterisation in order to identify individuals at an increased risk of developing cholangiopathy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor‐related cholangiopathy: Novel clinicopathological description of a multi‐centre cohort

Berry

Kotha

Zen

et al. 2022

Liver International

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“…8 Although ICIs can cause immune-related adverse reactions (IRAEs), 9 the IRAE frequency is low. However, malnutrition due to colitis with severe diarrhea, pericarditis, 10 hepatotoxicity, 11 and circulatory disturbance due to IRAEs to lower extremity soft tissue are reported causes of BLE. 12,13 Many patients who develop IRAEs recover with corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Using Compression Therapy to Treat Bilateral Lower Limb Edema in Patients with Lung Cancer: A Case Series

Kayauchi,

Nagatsu,

Satoh

2023

Adv Skin Wound Care

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Although rare, marked bilateral leg edema (BLE) can occur in patients with lung cancer. Systemic therapy for the underlying disease is important, but adjunct therapy might also be helpful. In this case series, the authors report on treating BLE in patients with lung cancer with compression therapy using elastic stockings and bandages. From April 2013 to March 2022, the authors conducted a retrospective survey of seven patients who developed marked BLE and received compression therapy. They evaluated effects based on improvements in subjective symptoms as well as objective findings 2 months after the start of the therapy. The bandage therapy was useful in patients who were driver-gene negative, but it was not effective in those who already had “progressive disease” with specific agents for their driver genes. No adverse events were observed. Compression therapy, even when attached or detached by nonmedical personnel, may provide favorable effects and should be considered as an adjunct treatment option in this population, in addition to effective systemic cancer therapy. These results indicate that a prospective clinical trial would be worthwhile.

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Pembrolizumab

2021

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Pembrolizumab-induced large duct cholangiopathy

Cited by 4 publications

References 4 publications

Immune checkpoint inhibitor‐related cholangiopathy: Novel clinicopathological description of a multi‐centre cohort

Immune checkpoint inhibitor‐related cholangiopathy: Novel clinicopathological description of a multi‐centre cohort

Using Compression Therapy to Treat Bilateral Lower Limb Edema in Patients with Lung Cancer: A Case Series

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