Year 2024 / Volume 116 / Number 7
Letter
Treatment of steroid-refractory immune checkpoint inhibitor-induced intestinal pseudo-obstruction with infliximab

383-384

DOI: 10.17235/reed.2023.9796/2023

Cong Dai, Yu-Hong Huang,

Abstract
Immune checkpoint inhibition therapy using targeted monoclonal antibodies is a relatively new therapeutic approach for patients with several cancer types including non-small cell lung cancer1. Targeted monoclonal antibodies based drugs can activate anti-tumor immunity by blocking immune checkpoint receptors (CTLA-4, PD-1 receptor and its ligand PD-L1), in order to restore T-cell effector function2,3. However, the use of immune checkpoint inhibitors can lead to a unique side effect profile termed as immune-related adverse events (irAEs). Loss of T-cell inhibition results in an enhanced immune response driven by T-cell activation and is capable of inducing an autoimmune-related inflammation in normal tissue as a consequence of impaired self tolerance4. These irAEs can potentially involve every organ system including gastrointestinal, dermatologic, hepatic, and endocrine toxicities. For example, Fernandez-Gordon Sanchez et al reported a patient with immune-mediated colitis and nonimmune-mediated cholestasic injury induced by pembrolizumab that was successfully treated with Ustekinumab5. We report a steroid-refractory case of lung adenocarcinoma patient with an unusual irAE (intestinal pseudo-obstruction) during the treatment with immune checkpoint inhibitors that could be successfully managed by the administration of infliximab.
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References
1. Gettinger S, Rizvi NA, Chow LQ, et al. Nivolumab monotherapy for first-line treatment of advanced non-small-cell lung cancer. J Clin Oncol 2016; 34: 2980-2987.
2. Friedman CF, Proverbs-Singh TA, Postow MA. Immune-related adverse effects of immune checkpoint inhibitors: a review. JAMA Oncol 2016; 2: 1346-1353.
3. Marrone KA, Brahmer JR. Using immune checkpoint inhibitors in lung cancer. Oncology 2016; 30: 713-721.
4. Freeman-Keller M, Kim Y, Cronin H, et al. Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clin Cancer Res 2016; 22: 886-894.
5. Fernandez-Gordon Sanchez FM, Gomez-Dominguez E, Paredes Ruiz D, et al. Ustekinumab for corticodependent immune-mediated colitis by pembrolizumab, an alternative for patients with concomitant liver injury. Rev Esp Enferm Dig 2022; 6: 356-357.
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Dai C, Huang Y. Treatment of steroid-refractory immune checkpoint inhibitor-induced intestinal pseudo-obstruction with infliximab. 9796/2023


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Publication history

Received: 21/06/2023

Accepted: 27/06/2023

Online First: 14/07/2023

Published: 08/07/2024

Article Online First time: 23 days

Article editing time: 383 days


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