纳武单抗诱导的溃疡性结肠炎发作缓解。

Remission of ulcerative colitis flare-up induced by nivolumab.

作者信息

Iwamoto Maho, Kato Kimitoshi, Moriyama Mitsuhiko, Yamaguchi Kenya, Takahashi Satoru

机构信息

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.

Division of Research Planning and Development, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.

出版信息

Int J Colorectal Dis. 2020 Sep;35(9):1791-1795. doi: 10.1007/s00384-020-03638-3. Epub 2020 May 26.

DOI:10.1007/s00384-020-03638-3

PMID:32458394

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7415029/

Abstract

BACKGROUND

Immune checkpoint inhibitors (ICIs) have been used to treat many cancers, but ICIs are rarely administered for malignant tumours coexisting with inflammatory bowel disease.

METHODS AND RESULTS

We report a 77-year-old man experiencing an ulcerative colitis (UC) flare-up after receiving nivolumab as third-line therapy for multiple metastases of renal cell carcinoma. Mild UC (proctitis form) had been diagnosed at age 59 years and remission was maintained for 17 years with only a low dose of 5-ASA. After nivolumab treatment, the patient developed diarrhoea, bloody stools and was hospitalised. Computed tomography revealed inflammation involving the entire colon and endoscopy revealed severe UC exacerbation. Histological analysis showed UC findings and also increased crypt apoptosis which is unusual for inflammatory bowel diseases, while being typical of ICI-induced colitis. As with ICI-induced colitis, this exacerbation was strongly suggested to have been caused by nivolumab, although remission was achieved by increasing the 5-ASA dose to 4000 mg without prednisolone.

CONCLUSION

The administration of ICI for UC is not as yet sufficiently safe and further research is required.

摘要

背景

免疫检查点抑制剂（ICIs）已被用于治疗多种癌症，但ICIs很少用于治疗与炎症性肠病共存的恶性肿瘤。

方法与结果

我们报告了一名77岁男性，在接受纳武单抗作为肾细胞癌多发转移的三线治疗后出现溃疡性结肠炎（UC）发作。患者59岁时被诊断为轻度UC（直肠炎型），仅通过低剂量的5-氨基水杨酸（5-ASA）维持缓解17年。接受纳武单抗治疗后，患者出现腹泻、便血并住院。计算机断层扫描显示整个结肠有炎症，内镜检查显示严重的UC恶化。组织学分析显示有UC表现，同时隐窝凋亡增加，这在炎症性肠病中不常见，但在ICI诱导的结肠炎中很典型。与ICI诱导的结肠炎一样，强烈提示这种恶化是由纳武单抗引起的，尽管在未使用泼尼松龙的情况下将5-ASA剂量增加到4000 mg后实现了缓解。