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

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 or...

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Autores principales: Acero Brand, Fanny Zulay, Suter, Nicolas, Adam, Jean-Philippe, Faulques, Bernard, Maietta, Antonio, Soulières, Denis, Blais, Normand
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857140/
https://www.ncbi.nlm.nih.gov/pubmed/29548299
http://dx.doi.org/10.1186/s40425-018-0332-z
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author Acero Brand, Fanny Zulay
Suter, Nicolas
Adam, Jean-Philippe
Faulques, Bernard
Maietta, Antonio
Soulières, Denis
Blais, Normand
author_facet Acero Brand, Fanny Zulay
Suter, Nicolas
Adam, Jean-Philippe
Faulques, Bernard
Maietta, Antonio
Soulières, Denis
Blais, Normand
author_sort Acero Brand, Fanny Zulay
collection PubMed
description 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.
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spelling pubmed-58571402018-03-22 Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab Acero Brand, Fanny Zulay Suter, Nicolas Adam, Jean-Philippe Faulques, Bernard Maietta, Antonio Soulières, Denis Blais, Normand J Immunother Cancer Case Report 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. BioMed Central 2018-03-16 /pmc/articles/PMC5857140/ /pubmed/29548299 http://dx.doi.org/10.1186/s40425-018-0332-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Acero Brand, Fanny Zulay
Suter, Nicolas
Adam, Jean-Philippe
Faulques, Bernard
Maietta, Antonio
Soulières, Denis
Blais, Normand
Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title_full Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title_fullStr Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title_full_unstemmed Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title_short Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
title_sort severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857140/
https://www.ncbi.nlm.nih.gov/pubmed/29548299
http://dx.doi.org/10.1186/s40425-018-0332-z
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