scholarly journals When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report

2021 ◽  
Vol 9 (3) ◽  
pp. e002337
Author(s):  
Marie-Léa Gauci ◽  
Barouyr Baroudjian ◽  
Celeste Lebbe ◽  
Olivier Roux
Keyword(s):  
Adverse Event ◽  
Differential Diagnosis ◽  
Case Report ◽  
Liver Biopsy ◽  
Combination Therapy ◽  
Immunosuppressive Treatment ◽  
Second Line ◽  
Related Adverse Event ◽  
Present Letter ◽  
Cancer Types

Immune-related hepatitis (IRH) is a frequent but poorly understood immune-related adverse event and its frequency increases since the use of combination therapy in several cancer types. Therefore, there is an urgent need to develop adapted guidelines to manage IRH.In the present letter, based on Ziogas et al report entitled ‘When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report’, several points are discussed: assessment of IRH severity and liver biopsy indication, immune-related cholangitis as a differential diagnosis for some IRH presentation, the need of steroids for IRH management or the indication for second line immunosuppressive treatment and finally, the possibility of immunotherapy resumption.

Susac’s syndrome as an immune-related adverse event after pembrolizumab: a case report

2019 ◽  
Vol 267 (1) ◽  
pp. 282-284 ◽  
Author(s):  
M. De Groot ◽  
A. Compter ◽  
A. J. De Langen ◽  
D. Brandsma
Keyword(s):  
Adverse Event ◽  
Case Report ◽  
Related Adverse Event ◽  
Susac’S Syndrome

scholarly journals Nivolumab-Induced, Late-Onset, Steroid-Sensitive, High-Grade Pneumonitis and Durable Tumor Suppression in Metastatic Renal Cell Carcinoma: A Case Report

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Vincent Louie Mendiola ◽  
Meghana Kesireddy ◽  
Bagi Jana
Keyword(s):  
Renal Cell Carcinoma ◽  
Adverse Event ◽  
Case Report ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Late Onset ◽  
Drug Discontinuation ◽  
Related Adverse Event ◽  
Grade 3

Nivolumab, an antiprogrammed death-1 checkpoint inhibitor, has been approved for use in unresectable/metastatic renal cell carcinoma (RCC). Nivolumab-induced pneumonitis, a rare, but often severe and potentially life-threatening immune-related adverse event, has been reported, typically, early during the treatment. Due to its low incidence, more studies are needed to better elucidate this condition and its possible effects on cancer progression. We now present a 57-year-old Hispanic male patient with metastatic RCC-clear cell type who, after his 34th cycle of nivolumab (16 months after being on nivolumab), developed a late-onset, immune-related adverse event (IRAE) including a grade 3 pneumonitis, which resolved completely, clinically, and on serial lung imaging with steroids and drug discontinuation. His cancer remained stable with no progression for 18 months despite discontinuation of nivolumab which showed tumor progression resistance. This case report is aimed at providing further information regarding the rare phenomena of a late-onset IRAE, in particular, a grade 3 nivolumab-induced pneumonitis which also responded rapidly to treatment, as well as at discussing this immunotherapy’s durable tumor suppressive effect and a possible associated factor to this phenomenon.

scholarly journals A case report of pembrolizumab-induced liver injury: The implication of CD8-positive lymphocytes in the immune-related adverse event

Kanzo ◽  
2018 ◽  
Vol 59 (10) ◽  
pp. 571-577 ◽  
Author(s):  
Masahiko Sue ◽  
Masayuki Ueno ◽  
Hiroyuki Takabatake ◽  
Takahisa Kayahara ◽  
Youichi Morimoto ◽  
...  
Keyword(s):  
Adverse Event ◽  
Case Report ◽  
Liver Injury ◽  
Related Adverse Event

Treatment-related adverse events of combination immune checkpoint inhibitors: Systematic review and meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15060-e15060
Author(s):  
Robin Park ◽  
Laércio Lopes da Silva ◽  
Ivy Riano ◽  
Cagney Cristancho ◽  
Anwaar Saeed
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Related Adverse Event ◽  
Adverse Event Data ◽  
Cancer Types ◽  
Grade 3

e15060 Background: Despite increasing clinical experience with immune checkpoint inhibitors and the recent publication of clinical practice guidelines for managing treatment-related adverse events, precise and nuanced checkpoint inhibitor data in the setting of combination therapy is lacking. Herein we have conducted a systematic review and meta-analysis of treatment-related adverse event data from clinical trials evaluating combination immune checkpoint inhibitors. Methods: Studies published in PubMed, Embase, and Cochrane Database from conception to September 28, 2019 were included in the meta-analysis. Studies were eligible for inclusion if combination immune checkpoint inhibitor therapy was evaluated in advanced unresectable cancer and treatment-related adverse event data were available. For comparison of severity of adverse events in combination versus monotherapy, only the studies containing monotherapy arms as a control population were included, while all were included for calculation of pooled incidence of selected adverse events. Pooled risk ratio (RR) was used for the comparison of combination versus monotherapy and the logit transformed proportion for calculation of pooled incidence. Between-study risk of bias was evaluated using the Begg's funnel plot and Egger's regression test. Subgroup analysis was conducted by combination regimen, cancer type, and dosing regimen. Results: A total of 18 studies comprising 2767 patients across 10 cancer types were included in the final analysis. Combination ICI was associated with a slightly higher risk of all-grade adverse events (RR 1.07 [95% CI 1.03-1.11]) and markedly greater risk of grade 3 or higher adverse events (RR 2.21 [95% CI 1.57-3.10]) compared to monotherapy ICI. Subgroup analyses showed significant differences in risk of grade 3 or higher adverse events between treatment type (PD-1+CTLA-4 and PD-L1+CTLA-4), among cancer types, and among dosing regimens (N1I3, N3I1 and D20T1). Incidence of all-grade adverse events was 0.905 [95% CI 0.842-0.945] and grade 3 or higher events/all-grade adverse events was 0.396 [95% CI 0.315-0.483]. The most common all-grade TRAEs were diarrhea/colitis, fatigue/asthenia, nausea/vomiting, rash, and pruritis. Conclusions: Combination ICI therapy has a significantly different treatment-related adverse event profile compared to monotherapy.

Myocarditis as an immune-related adverse event with ipilimumab/nivolumab combination therapy for metastatic melanoma

2016 ◽  
Vol 26 (3) ◽  
pp. 319-320 ◽  
Author(s):  
Anurag Mehta ◽  
Arjun Gupta ◽  
Franck Hannallah ◽  
Thomas Koshy ◽  
Sharon Reimold
Keyword(s):  
Adverse Event ◽  
Combination Therapy ◽  
Metastatic Melanoma ◽  
Related Adverse Event

scholarly journals Myocarditis as an immune-related adverse event following treatment with ipilimumab and nivolumab combination therapy for metastatic renal cell carcinoma: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yasuyuki Miyauchi ◽  
Hirohito Naito ◽  
Hiroyuki Tsunemori ◽  
Ryosuke Tani ◽  
Yusuke Hasui ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Adverse Event ◽  
Combination Therapy ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Immune Checkpoint ◽  
Renal Cell ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Related Adverse Event

Abstract Background Immune checkpoint inhibitors are new immunotherapy drugs globally used for many malignancies, including renal cell carcinoma. Myocarditis as an immune-related adverse event is rare but highly fatal, suggesting that its frequency may be higher than reported. This paper describes a case of myocarditis that developed asymptomatically following ipilimumab and nivolumab combination therapy for renal cell carcinoma. Case presentation A 71-year-old Asian man who presented to hospital with fever, fatigue, and weight loss of approximately 10 kg within 2 months was diagnosed with Xp.11.2 translocation renal cell carcinoma. Computed tomography revealed multiple lung masses, mediastinal lymph node enlargement, and a level II tumor thrombus reaching the inferior vena cava (cT3bN0M1; International Metastatic Renal Cell Carcinoma Database Consortium, poor risk). Ipilimumab/nivolumab combination therapy was started as induction therapy. The patient experienced acute interstitial nephritis as an immune-related adverse event after treatment initiation; however, a good response to steroid therapy was observed. The antitumor effect of the immunotherapy was notable. Although he experienced pulmonary embolism, it seemed asymptomatic and harmless; thus, a second infusion was introduced. From the eighth day, he demonstrated rapidly worsening cardiogenic shock with asymptomatic electrocardiographic changes and drastic drop in cardiac biomarkers, and a diagnosis of myocarditis as an immune-related adverse event was made. Although immediate methylprednisolone mini-pulse therapy followed by tapered prednisolone prevented mortality, extensive myocardial fibrosis with marked ejection fraction decline persisted as a sequela. Consequently, follow-up without treatment was instituted; however, much of the tumor response initially observed was maintained over several months. Conclusion Physicians treating patients with immune checkpoint inhibitors should be aware of their potentially life-threatening cardiotoxic effects. This study emphasized the importance of a high index of suspicion, prompt diagnosis, and early intervention in patients who present with cardiac abnormalities and possible myocarditis after receiving immunotherapy.

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