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Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature

Nivolumab is a promising monoclonal antibody inhibitor of programmed death-1, a protein on the surface of T-cells. As such, it is approved for use in patients with multiple advanced malignancies and can significantly elongate progression-free survival. However, monoclonal antibody inhibitors can lea...

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Autores principales: Dibos, Miriam, Dumoulin, Johanna, Mogler, Carolin, Wunderlich, Silke, Reichert, Maximilian, Rasch, Sebastian, Schmid, Roland M., Ringelhan, Marc, Ehmer, Ursula, Lahmer, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10381004/
https://www.ncbi.nlm.nih.gov/pubmed/37510756
http://dx.doi.org/10.3390/jcm12144641
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author Dibos, Miriam
Dumoulin, Johanna
Mogler, Carolin
Wunderlich, Silke
Reichert, Maximilian
Rasch, Sebastian
Schmid, Roland M.
Ringelhan, Marc
Ehmer, Ursula
Lahmer, Tobias
author_facet Dibos, Miriam
Dumoulin, Johanna
Mogler, Carolin
Wunderlich, Silke
Reichert, Maximilian
Rasch, Sebastian
Schmid, Roland M.
Ringelhan, Marc
Ehmer, Ursula
Lahmer, Tobias
author_sort Dibos, Miriam
collection PubMed
description Nivolumab is a promising monoclonal antibody inhibitor of programmed death-1, a protein on the surface of T-cells. As such, it is approved for use in patients with multiple advanced malignancies and can significantly elongate progression-free survival. However, monoclonal antibody inhibitors can lead to adverse hepatic reactions, which in rare cases result in further hepatic damage. Herein, we present a case of a patient with locally advanced gastric carcinoma treated with fluorouracil, oxaliplatin, docetaxel and the checkpoint inhibitor nivolumab. Five months after her first dosage of nivolumab and without a preexisting liver disease, she presented with transaminitis. During the course of her stay, the patient developed status epilepticus, which required mechanical ventilation followed by fulminant hepatic failure. A subsequent liver biopsy revealed severe liver damage with extensive confluent parenchymal necrosis corresponding to checkpoint-inhibitor-induced hepatitis. Alternative reasons for this hepatic failure were ruled out. Despite aggressive therapeutic interventions including corticosteroids and plasma exchange, the patient died due to liver failure. Although hepatic failure is rarely seen in patients with checkpoint inhibitor therapy, it requires early awareness and rapid intervention.
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spelling pubmed-103810042023-07-29 Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature Dibos, Miriam Dumoulin, Johanna Mogler, Carolin Wunderlich, Silke Reichert, Maximilian Rasch, Sebastian Schmid, Roland M. Ringelhan, Marc Ehmer, Ursula Lahmer, Tobias J Clin Med Case Report Nivolumab is a promising monoclonal antibody inhibitor of programmed death-1, a protein on the surface of T-cells. As such, it is approved for use in patients with multiple advanced malignancies and can significantly elongate progression-free survival. However, monoclonal antibody inhibitors can lead to adverse hepatic reactions, which in rare cases result in further hepatic damage. Herein, we present a case of a patient with locally advanced gastric carcinoma treated with fluorouracil, oxaliplatin, docetaxel and the checkpoint inhibitor nivolumab. Five months after her first dosage of nivolumab and without a preexisting liver disease, she presented with transaminitis. During the course of her stay, the patient developed status epilepticus, which required mechanical ventilation followed by fulminant hepatic failure. A subsequent liver biopsy revealed severe liver damage with extensive confluent parenchymal necrosis corresponding to checkpoint-inhibitor-induced hepatitis. Alternative reasons for this hepatic failure were ruled out. Despite aggressive therapeutic interventions including corticosteroids and plasma exchange, the patient died due to liver failure. Although hepatic failure is rarely seen in patients with checkpoint inhibitor therapy, it requires early awareness and rapid intervention. MDPI 2023-07-12 /pmc/articles/PMC10381004/ /pubmed/37510756 http://dx.doi.org/10.3390/jcm12144641 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Dibos, Miriam
Dumoulin, Johanna
Mogler, Carolin
Wunderlich, Silke
Reichert, Maximilian
Rasch, Sebastian
Schmid, Roland M.
Ringelhan, Marc
Ehmer, Ursula
Lahmer, Tobias
Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title_full Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title_fullStr Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title_full_unstemmed Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title_short Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
title_sort fulminant liver failure after treatment with a checkpoint inhibitor for gastric cancer: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10381004/
https://www.ncbi.nlm.nih.gov/pubmed/37510756
http://dx.doi.org/10.3390/jcm12144641
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