Vanishing bile duct syndrome following pembrolizumab infusion: case report and review of the literature
| Autor: | Maria Gemelli, Marco Carbone, Maria I Abbate, Maddalena Mancin, Nicola Zucchini, Francesca Colonese, Pietro Invernizzi, Paolo Bidoli, Diego Cortinovis |
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| Přispěvatelé: | Gemelli, M, Carbone, M, Abbate, M, Mancin, M, Zucchini, N, Colonese, F, Invernizzi, P, Bidoli, P, Cortinovis, D |
| Rok vydání: | 2021 |
| Předmět: |
Male
Lung Neoplasms Immunology Bile Duct Diseases Syndrome Antibodies Monoclonal Humanized lung cancer Fatal Outcome Oncology Carcinoma Non-Small-Cell Lung immune-related adverse event Humans vanishing bile duct syndrome Immunology and Allergy Bile Ducts immune-related hepatiti immunotherapy pembrolizumab Immune Checkpoint Inhibitors Aged |
| Zdroj: | Immunotherapy. |
| ISSN: | 1750-7448 1750-743X |
| DOI: | 10.2217/imt-2021-0078 |
| Popis: | PD-1/PD-L1 inhibitors demonstrate high efficacy in non-small-cell lung cancer and are now routinely used in clinical practice. Severe immune-related adverse events are reported in about 5% of patients, requiring hospitalization and possibly leading to death. We present a rare case of vanishing bile duct syndrome that arose a few days after the first pembrolizumab infusion. Laboratory tests and radiological imaging studies were performed to orient diagnosis and monitor the disease, while the evidence of ductal loss on the histological sample was pathognomonic for vanishing bile duct syndrome. High-dose steroid therapy and immunosuppressors were administered, resulting in scarce efficacy. Prompt recognition and management of similar conditions is crucial to avoid fatal events. Further studies are needed to investigate new drugs for steroid-refractory conditions.Plain language summary Immunotherapy has demonstrated high efficacy in lung cancer and is commonly used in clinical practice. Despite the good tolerability, severe immune-related adverse events may occur, requiring hospitalization and possibly leading to death. We present a case of vanishing bile duct syndrome (a rare and potentially lethal condition characterized by progressive destruction of small bile ducts) which arose a few days after the first pembrolizumab infusion. Laboratory tests and radiological imaging were performed to orient diagnosis and monitor disease; a histological sample was required for vanishing bile duct syndrome diagnosis. High-dose steroid therapy and immunosuppressors were administered, with scarce efficacy. Prompt recognition and management of similar conditions is crucial to avoid fatal events. Further studies are needed to investigate new drugs for steroid-refractory conditions. |
| Databáze: | OpenAIRE |
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