Department of Dermatology, Saint-Louis Hospital, 75475 Paris Cedex 10, France.
Melanoma Res. 2013 Jun;23(3):227-30. doi: 10.1097/CMR.0b013e32835fb524.
Ipilimumab (anti-CTLA-4 antibody) is a new tool for the treatment of metastatic melanoma patients that has led to an improvement in survival rates worldwide. New types of toxicities have been described with ipilimumab called 'immune-related adverse events' or irAEs. Here, we report an acute and steroid resistant case of ipilimumab-induced colitis treated with infliximab in a melanoma stage IV AJCC patient. The patient presented with acute grade 3 diarrhea after the second perfusion of ipilimumab. After the administration of intravenous steroids, the patient continued to have grade 2 diarrhea with erythematous mucous with several ulceration sites on rectosigmoidoscopy. Infliximab perfusion (5 mg/kg) was performed and resulted in resolution of symptoms within 2 days with complete healing was observed by rectal sigmoidoscopy on day 7. After failure of two further lines of chemotherapy, the patient died 10 months after the diagnosis of stage IVM1C melanoma. Treatment algorithms exist for the management of these digestive adverse events; however, some points remain unclear. No predictive marker for the occurrence of this digestive toxicity has been validated to date. Modes of administration of steroids and dosage are not clearly defined, except in cases of acute abdomen; surgery is difficult to propose for patients with a poor prognosis. Infliximab is another option for the treatment of steroid-resistant ipilimumab-induced colitis but its use in metastatic melanoma raises questions of its possible impact on the evolution of cancer. We reviewed at least 19 cases published of infliximab administration for ipilimumab-mediated colitis. Unfortunately, tolerance and cancer evolution have scarcely been reported. Thus, because more patients are being treated with CTLA-4 blockade, management of ipilimumab-induced colitis requires further studies.
易普利姆玛（抗 CTLA-4 抗体）是一种新的治疗转移性黑色素瘤患者的方法，已导致全球生存率的提高。易普利姆玛引起的新型毒性已被描述为“免疫相关不良事件”或 irAEs。在这里，我们报告了一例 IV 期 AJCC 黑色素瘤患者用英夫利昔单抗治疗的易普利姆玛诱导结肠炎的急性和激素耐药病例。该患者在接受第二次易普利姆玛灌注后出现急性 3 级腹泻。静脉注射激素后，患者继续出现 2 级腹泻，直肠乙状结肠镜检查显示红斑性黏膜有几个溃疡部位。进行英夫利昔单抗灌注（5mg/kg），症状在 2 天内得到缓解，第 7 天直肠乙状结肠镜检查发现完全愈合。在二线化疗失败两次后，该患者在诊断为 IVM1C 期黑色素瘤后 10 个月死亡。存在针对这些消化系统不良事件的管理治疗方案；然而，仍有一些方面尚不清楚。迄今为止，尚未验证发生这种消化毒性的预测标志物。除了急性腹痛外，类固醇的给药方式和剂量均未明确规定；对于预后不良的患者，手术也难以提出。英夫利昔单抗是治疗激素耐药性易普利姆玛诱导结肠炎的另一种选择，但在转移性黑色素瘤中的使用引发了对其可能对癌症演变产生影响的质疑。我们至少审查了 19 例已发表的英夫利昔单抗治疗易普利姆玛介导的结肠炎的病例。不幸的是，耐受性和癌症演变很少被报道。因此，由于更多的患者正在接受 CTLA-4 阻断治疗，易普利姆玛诱导的结肠炎的管理需要进一步的研究。
