Severe Gastritis Due to Nivolumab Treatment of a Metastatic Melanoma Patient

Samonis, George; Bousmpoukea, Aikaterini; Molfeta, A.; Kalkinis, Antonios D.; Petraki, Kalliopi; Koutserimpas, Christos; Bafaloukos, Dimitrios

doi:10.3390/diagnostics12112864

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…However, the immune-checkpoint inhibitors-induced inflammatory process usually involves multiple sites of the gastrointestinal tract along with the colonic mucosa, with concomitant gastric, duodenum, and terminal ileum endoscopic changes. Although isolated immune-related gastritis was considered rare, the number of reported cases has been increasing in recent years, and it is expected to further increase with the wider use of combined anti-PD-1 and anti-CTLA-4 immunotherapy and anti-PD-1 in the adjuvant setting [6][7][8][9]. The onset of immune-related gastritis has been observed at any time during ICIs administration.…”

Section: Discussionmentioning

confidence: 99%

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Cytomegalovirus gastritis as a rare adverse event during combined ipilimumab and nivolumab in a patient with melanoma

Indini,

Gueli,

Cerati

et al. 2024

Melanoma Research

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Immunotherapy has improvedsurvival outcomes of patients with advanced melanoma. Lower gastrointestinal tract immune-related adverse events (irAEs) are common during treatment; however, gastritis is not frequently observed. Herein, we report a case of severe cytomegalovirus (CMV)-related gastritis in a patient treated with ipilimumab and nivolumab for metastatic melanoma. This report presents a 60-year-old woman with stage IV BRAF wild-type melanoma. t. After the second course of ipilimumab-nivolumab, the patient reported epigastric discomfort after meals, anorexia, and subsequent nausea, vomiting, epigastric pain, and weight loss. Disease staging with PET/CT scan showed very good partial response and diffuse gastroduodenitis. The patient underwent esophagogastroduodenoscopy, showing severe esophageal candidiasis and diffuse hemorrhagic, edematous, and ulcerative mucosa in the whole gastric wall. Biopsies of the gastric wall were obtained. Before receipt of the final pathology report, the patient was empirically started on corticosteroids based on the clinical suspicion of immune-related gastritis, without improvement of symptoms. The hematoxylin-eosin staining demonstrated active gastritis with diffuse nuclear cytopathic viral inclusions in epithelial and interstitial cells; CMV infection was confirmed with immunohistochemical staining. The patient startedganciclovir and fluconazole, with rapid improvement of symptoms. This case presents a rare instance of CMV gastritis in a patient receiving combined anti-PD1 and anti-CTLA4 , in the absence of immune-suppression to manage an irAE. In the case of suggestive symptoms of irAEs, a high index of clinical suspicion is required to rule out concomitant or isolated infective disease. Guidelines for prophylaxis and treatment of these patients are needed, to optimize treatment results.

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Section: Discussionmentioning

confidence: 99%

“…However, increased cases of upper gastrointestinal tract toxicity (e.g. esophagitis, gastritis, and duodenitis) are being reported [5][6][7][8][9], even in the absence of concurrent enterocolitis.…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus gastritis as a rare adverse event during combined ipilimumab and nivolumab in a patient with melanoma

Indini,

Gueli,

Cerati

et al. 2024

Melanoma Research

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“…One of the more commonly used PPIs was pantoprazole[ 4 , 5 , 7 , 8 ]. In some of the cases that reported improvement in symptoms, PPIs were used in combination with other medications, namely – prednisone, methylprednisolone[ 4 , 7 , 8 , 10 , 12 , 21 ] or infliximab[ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Nivolumab-induced tumour-like gastritis: A case report

Cijauskaite,

Kazenaite,

Strainiene

et al. 2023

World J Clin Cases

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BACKGROUND Immune checkpoint inhibitors are one of the modern treatment methods for advanced malignancies. However, this group of medications is also associated with various immune-related adverse events, such as colitis or pneumonitis. Immune checkpoint inhibitor-induced gastritis is a less common adverse event. CASE SUMMARY We describe a 64-year-old woman presenting with diarrhea, nausea, and discomfort in the upper abdominal region. The patient had a history of metastatic lung cancer, which was treated with nivolumab. During the first endoscopy, an infiltrating gastric tumour was suspected. Later, based on endoscopic, histological and radiological findings, nivolumab-induced gastritis was diagnosed. The patient was successfully treated with three courses of omeprazole. CONCLUSION As a consequence of the increased use of immune checkpoint inhibitors, a growing number of reported immune-related adverse events could be expected. The diagnosis of immune checkpoint inhibitor-induced gastritis should be considered when assessing a patient treated with nivolumab with upper gastrointestinal distress.

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Nivolumab

2023

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Severe Gastritis Due to Nivolumab Treatment of a Metastatic Melanoma Patient

Cited by 4 publications

References 16 publications

Cytomegalovirus gastritis as a rare adverse event during combined ipilimumab and nivolumab in a patient with melanoma

Cytomegalovirus gastritis as a rare adverse event during combined ipilimumab and nivolumab in a patient with melanoma

Nivolumab-induced tumour-like gastritis: A case report

Nivolumab

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