Jingjing Zhang; Shasha Zhang; Shuo Xu; Xiaoyun Zhang; Jiasong Li; Zhengzheng Ji; Qingyi Liu; Zhanjun Guo
Abstract
Immune Checkpoint Inhibitors (ICIs) have dramatically revolutionized the therapeutic approaches by which we treat a series of cancers accompanied by immune-related adverse events (irAEs). Herein, we reported an intrahepatic cholangiocarcinoma male patient with a history of ankylosing spondylitis developing ...
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Immune Checkpoint Inhibitors (ICIs) have dramatically revolutionized the therapeutic approaches by which we treat a series of cancers accompanied by immune-related adverse events (irAEs). Herein, we reported an intrahepatic cholangiocarcinoma male patient with a history of ankylosing spondylitis developing pulmonary arterial hypertension (PAH) under ICI combined therapy with pembrolizumab and lenvatinib. The indirect measurement of cardiac ultrasound showed a pulmonary artery pressure (PAP) of 72mmHg after 21 three-week cycles of ICI combined therapy. The patient partially responded to the treatment of glucocorticoid and mycophenolate mofetil. The PAP decreased to 55mmHg 3 months after the ICI combined therapy was discontinued, but increased to 90mmHg after the ICI combined therapy was rechallenged. We treated him with adalimumab -an antitumor necrosis factor-alpha (ani-TNF-α) antibody- combined with glucocorticoid and immunosuppressants under lenvatinib monotherapy. The patient responded again with PAP decreasing to 67mmHg after 2 two-week cycles of adalimumab. Accordingly, we diagnosed him to have irAE-related PAH. Our findings supported the use of glucocorticoid disease-modifying antirheumatic drugs (DMARDs) as a treatment option in refractory PAH.
Sha Sha Zhang; Dong Wang; Ping An Ding; Yu Fei Zhao; Xiao Yun Zhang; Qun Zhao
Abstract
Background: Anti-programmed cell death 1(anti-PD-1) antibodies are immune checkpoint inhibitors (ICIs) used as a treatment option for a number of cancers to expand lifespan. However, the toxicity caused by ICIs is often unpredictable and can be occasionally life-threatening. Objective: To evaluate the ...
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Background: Anti-programmed cell death 1(anti-PD-1) antibodies are immune checkpoint inhibitors (ICIs) used as a treatment option for a number of cancers to expand lifespan. However, the toxicity caused by ICIs is often unpredictable and can be occasionally life-threatening. Objective: To evaluate the immune-related adverse events (irAEs) induced by Camrelizumab, an anti-PD-1 antibody in a patient with gastric cancer. Case: The patient was a 32-year-old man who was diagnosed with stage IIIA gastric adenocarcinoma (cT4aN1M0) in pre-operative evaluation. However, pancreatic invasion and peritoneal metastasis were found during surgery. He received a three-week cycle of 200 mg Camrelizumab combined with systemic chemotherapy. After the fifth administration of Camrelizumab, the patient displayed irAE mimicking Behcet's disease with oral and penile ulcers, skin and abdominal incision lesions. Camrelizumab was permanently discontinued, but systemic chemotherapy was continued. The symptoms were improved with discontinuation of Camrelizumab and administration of glucocorticoid and immunosuppressive agents for 8 weeks, but suspicious liver metastases occurred and carbohydrate antigen 19-9 showed an increasing trend in the meantime. Given the significant improvement in the patient's symptoms after discontinuation of Camrelizumab and administration of corticosteroids and immunosuppressants, we assumed that these treatments may play a role in the rehabilitation of patients. Conclusion: Severe irAEs occur at a low frequency when anti-PD-1 antibodies are used as monotherapy. Whether anti-PD-1 antibodies combined with systemic chemotherapy increase the incidence of irAEs is not certain.
