Three cases of immune cholangitis related to anti–programmed cell death and programmed cell death ligand agents for the treatment of non-small cell lung cancer

Fouchard, Maxime; Jantzem, Hélène; Quéré, Gilles; Descourt, R.; Robinet, G.; Poureau, Pierre-Guillaume

doi:10.1016/j.ejca.2019.04.022

Cited by 19 publications

(12 citation statements)

References 5 publications

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“…The main clinical and radiographic features of ICI-related cholangitis are dilation of intrahepatic and extrahepatic bile ducts without obstruction, diffuse thickening of extrahepatic bile ducts, changes in serum levels of liver enzymes, and CD8+ T cell infiltration in the hilar area of the liver on histology. Symptoms should be regressed with corticosteroid therapy or discontinuation of the ICI (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). In a report of ICIrelated cholangitis caused by pembrolizumab, CT showed edema-like thickening of the gallbladder wall and common bile duct with dilatation of the intrahepatic bile ducts.…”

Section: Discussionmentioning

confidence: 99%

Pneumonitis, appendicitis, and biliary obstruction during toripalimab treatment in a patient with extensive-stage small-cell lung cancer: a case report

Wang

Jiang

et al. 2021

Ann Palliat Med

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In recent years, immune checkpoint inhibitors (ICIs) have become a standard treatment for patients with advanced lung cancers. With the widespread use of immunotherapy in clinical practice, immunerelated adverse events (irAEs) have become increasingly common. This case report details a 72-year-old man with small-cell lung cancer (SCLC) who developed pneumonitis, appendicitis, and biliary obstruction during treatment with toripalimab. The patient was initially diagnosed with limited-stage SCLC in January 2019 and completed 5 sequential cycles of etoposide/cisplatin (EP) and radiotherapy (60 Gy/30 F). The overall response was complete response (CR) after first line treatment. He developed radiation pneumonitis after completion of radiotherapy, which responded well to symptomatic treatment. Due to newly diagnosed bone metastasis, he was administered toripalimab intravenously every 3 weeks and 12 mg anlotinib orally once a day from January 2020. By the third cycle, the patient presented with electrocardiographic abnormalities, gingival swelling and pain, and hoarseness, and consequently, the anlotinib was suspended. After 4 cycles, he developed suppurative appendicitis, which was managed successfully with anti-inflammatory agents. He then presented with shortness of breath on exertion and after a comprehensive examination, he was diagnosed with ICI-related-pneumonitis.After 6 weeks of treatment with methylprednisolone, the shortness of breath was mostly relieved and treatment continued. In June 2020, the patient developed severe vomiting. Computed tomography (CT) indicated biliary obstruction, and at endoscopic retrograde cholangiopancreatography (ERCP) there was edema of the major papilla of the duodenum. The patient's symptoms were relieved after treatment with gastric acid suppression and antiemetics. Re-examination by magnetic resonance imaging (MRI) showed that the biliary obstruction had been resolved. Although the disease progressed after immunotherapy, no tumor tissue related to the biliary obstruction was detected, and this was therefore classified as an irAE.

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Section: Discussionmentioning

confidence: 99%

Pneumonitis, appendicitis, and biliary obstruction during toripalimab treatment in a patient with extensive-stage small-cell lung cancer: a case report

Wang

Jiang

et al. 2021

Ann Palliat Med

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“…To our knowledge, 10 cases of pembrolizumab-related cholangitis have been reported in the English literature ( Table 1 ) [ [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. The underlying malignancies were melanoma/NSCLC/mesothelioma/bladder cancer in 2/5/1/2 cases, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Ooi

Tobino

Sakabe

et al. 2020

Respiratory Medicine Case Reports

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Large-cell carcinoma (LCC) of the lung is defined as an undifferentiated non-small cell lung cancer (NSCLC) and accounts for approximately 7.5% of lung cancers. Immune checkpoint inhibitors (ICIs) may be effective for LCC, but there has been no firm evidence due to its low frequency. We herein report an 80-year-old woman with LCC of the lung who was successfully treated with pembrolizumab but developed sclerosing cholangitis as an immune-related adverse event. This case highlights the efficacy of ICIs for LCC as well as the importance of the immediate and detailed management of ICI-related sclerosing cholangitis.

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“…However, they can cause irAEs . Cholangitis is a rare irAE and four cases of pembrolizumab‐induced SSC in NSCLC patients have been reported .…”

Section: Discussionmentioning

confidence: 99%

“…Anti‐PD‐1 antibody‐related cholangitis was mainly reported in NSCLC patients receiving nivolumab (Table ) . Nivolumab‐related cholangitis was characterized by (1) extrahepatic bile duct dilation without obstruction; (2) diffuse hypertrophy of the extrahepatic bile duct wall; (3) increase in the biliary enzymes ALP and GGT relative to the hepatic enzymes AST and ALT; (4) absence of the serum immunological markers ANA, AMA, anti‐smooth muscle antibody, and IgG4; (5) CD8 + T cell infiltration in the portal area by liver biopsy; and (6) a moderate‐to‐poor response to steroid therapy .…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab‐induced secondary sclerosing cholangitis in a non‐small cell lung cancer patient

Matsumoto

Watanabe

Kobayashi

et al. 2020

Respirology Case Reports

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A 50-year-old woman with stage IV lung adenocarcinoma received seven cycles of pembrolizumab as third-line chemotherapy. Following the failure of pembrolizumab, she commenced fourth-line chemotherapy of docetaxel and ramucirumab. The patient complained of epigastric pain and a computed tomography (CT) scan revealed oedema-like thickening of the gallbladder wall, dilation of the bile ducts from the common to the intrahepatic bile ducts, and thickening of the common bile duct wall without any visible obstructions. Accumulation of fluorodeoxyglucose (FDG) in the gallbladder wall and bile duct was also detected with positron emission tomography (PET)-CT. A biopsy of the extrahepatic bile duct showed non-specific inflammation. Antibiotic treatment was not effective and pathogens were not detected. The patient was diagnosed with secondary sclerosing cholangitis (SSC) by pembrolizumab. She received 80 mg/day of prednisolone (PSL); however, SSC recurred with tapering of PSL. SSC then improved with steroid pulse therapy and subsequently 50 mg/day azathioprine and 80 mg/day PSL.

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Three cases of immune cholangitis related to anti–programmed cell death and programmed cell death ligand agents for the treatment of non-small cell lung cancer

Cited by 19 publications

References 5 publications

Pneumonitis, appendicitis, and biliary obstruction during toripalimab treatment in a patient with extensive-stage small-cell lung cancer: a case report

Pneumonitis, appendicitis, and biliary obstruction during toripalimab treatment in a patient with extensive-stage small-cell lung cancer: a case report

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

Pembrolizumab‐induced secondary sclerosing cholangitis in a non‐small cell lung cancer patient

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