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Successful Treatment of an Immune-Mediated Colitis Induced by Checkpoint Inhibitor Therapy in a Patient with Advanced Melanoma
- Source :
- Case Reports in Gastroenterology, Vol 14, Iss 3, Pp 554-560 (2020), Case Reports in Gastroenterology
- Publication Year :
- 2020
- Publisher :
- Karger Publishers, 2020.
-
Abstract
- Immune checkpoint inhibitors (ICIs) have been used as immunotherapeutic agents in several malignancies because of their ability to modify the T cell-mediated response against tumor cells. Dual checkpoint inhibition improves remission rates in patients with metastatic melanoma compared to monotherapy. However, a higher incidence of toxicity, including immune-related colitis, has been reported before. A 54-year-old female was diagnosed with malignant melanoma on her left upper arm. Because of progressive metastatic disease, a rescue therapy with nivolumab (Opdivo®) 1 mg/kg and ipilimumab (Yervoy®) 3 mg/kg was initiated and a clinical and radiological remission was achieved. Two weeks after completing the third cycle of the ICI therapy, the patient presented with persistent hemorrhagic diarrhea, nausea and abdominal pain. A diagnostic colonoscopy revealed multiple ulcerative lesions and hemorrhagic colitis of the sigmoid and rectum. Due to the ongoing treatment with nivolumab and ipilimumab, the diagnosis of a checkpoint inhibitor-induced colitis was made and immunosuppression with local and systemic steroids, such as mesalazine was initiated. In order to achieve a long-lasting steroids reduction, we decided to start with infliximab (Remicade® 5 mg/kg body weight i.v. every 2 weeks). Clinical remission was achieved and prednisolone could be subsequently discontinued. Infliximab, in combination with mesalazine, could successfully induce a long-lasting remission without steroids. The treatment of ICI-induced colitis did not lead to a reoccurrence of malignant melanoma after 2 years of follow-up.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Single Case
immune checkpoint inhibitor
Ipilimumab
Gastroenterology
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Mesalazine
Internal medicine
medicine
Colitis
ipilimumab
lcsh:RC799-869
nivolumab
business.industry
Melanoma
Immunosuppression
medicine.disease
Infliximab
chemistry
030220 oncology & carcinogenesis
Prednisolone
immune-related adverse events
030211 gastroenterology & hepatology
lcsh:Diseases of the digestive system. Gastroenterology
Nivolumab
business
infliximab
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 16620631
- Volume :
- 14
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Case Reports in Gastroenterology
- Accession number :
- edsair.doi.dedup.....4e822f5278143b13f7639f8d0d28eed8