Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab

Autor: Normand Blais, Jean-Philippe Adam, Denis Soulières, Antonio Maietta, Nicolas Suter, Bernard Faulques, Fanny Zulay Acero Brand
Rok vydání: 2017
Předmět:
Male
Mucositis
Cancer Research
medicine.medical_specialty
Esophageal Mucosa
medicine.medical_treatment
Immunology
Programmed Cell Death 1 Receptor
Anti-Inflammatory Agents
Case Report
Pembrolizumab
Antibodies
Monoclonal
Humanized
Gastroenterology
lcsh:RC254-282
03 medical and health sciences
0302 clinical medicine
Antineoplastic Agents
Immunological
Prednisone
Internal medicine
Immune-related adverse event
Immunology and Allergy
Medicine
Humans
Esophagitis
030212 general & internal medicine
Glucocorticoids
Aged
Pharmacology
business.industry
Squamous Cell Carcinoma of Head and Neck
Mouth Mucosa
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Head and neck squamous-cell carcinoma
Squamous carcinoma
Radiation therapy
Oncology
Methylprednisolone
Head and Neck Neoplasms
030220 oncology & carcinogenesis
Molecular Medicine
Larynx
business
medicine.drug
Zdroj: Journal for Immunotherapy of Cancer
Journal for ImmunoTherapy of Cancer, Vol 6, Iss 1, Pp 1-5 (2018)
ISSN: 2051-1426
Popis: Background Pembrolizumab is an anti–programmed death 1 (PD-1) receptor monoclonal antibody that has shown activity as second line treatment for metastatic head and neck squamous cell carcinoma (HNSCC). Immune-related adverse events are now well described complications of PD-1 inhibitors and most organ sites have been shown to be potentially affected. Case presentation We describe a 69-year old patient with a relapsed squamous cell carcinoma of the supraglottic larynx with lung metastasis after receiving adjuvant concurrent cisplatin and radiotherapy. This patient was treated with pembrolizumab and benefitted from therapy with major radiological improvement of disease. After 14 cycles of pembrolizumab 200 mg IV each 3 weeks, he experienced dysphagia that evolved to a grade 4 oral cavity and pharynx mucositis and esophagitis. Histologic analysis showed ulcerative esophagitis associated with granulation tissue. Pembrolizumab was discontinued and IV methylprednisolone 2 mg/kg/day was initiated. Two days later, the patient reported a 50% recovery in his symptoms which were completely resolved after 2 weeks. Methylprednisolone was switched to oral prednisone and a taper was planned over 8 weeks. During the fourth week of taper, the patient presented recurrence of grade 1 oral mucositis. Prednisone was increased 2 mg/kg/day for 2 weeks followed by slower tapering over a period of 5 months. Pembrolizumab was not reinitiated. Conclusion This is the first described case of grade 4 immune mucositis and esophagitis associated with pembrolizumab. Because the use of pembrolizumab is increasing in oncology, pharmacists and physicians should be aware of this rare manifestation.
Databáze: OpenAIRE
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