Fellouah Massine, Auclair Marie-Hélène, Fortin Suzanne, Berdugo Jérémie, de Guerké Lara
Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CIUSSS de l'Est-de-l'Île-de-Montréal, Université de Montréal, Montréal, QC, Canada.
Gynecol Oncol Rep. 2023 Jun 28;49:101235. doi: 10.1016/j.gore.2023.101235. eCollection 2023 Oct.
Pembrolizumab is a monoclonal antibody targeting the programmed cell death protein 1 (PD-1). It is used in the management and treatment of various oncologic conditions. To name a few: refractory and advanced melanoma, non-small cell lung cancer (NSCLC), head and neck squamous cell carcinoma (HNSCC), renal cell carcinoma and gastric cancer. It is also approved for metastatic mismatch repair deficient (dMMR) endometrial carcinoma after failure of front-line chemotherapy. Lenvatinib is an oral multikinase inhibitor that targets vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor-a, RET, and KIT. The combination of lenvatinib and pembrolizumab has proven to be more effective together than as monotherapy. Here, we present the case of a patient who probably developed lenvatinib-related esophagitis, a complication not previously described in the literature to our knowledge.Case presentation.We describe a 65 years old female with metastatic endometrial cancer who presented dysphagia after a few months of lenvatinib plus pembrolizumab treatment. Upper endoscopy results revealed a very fragile upper esophageal mucosa with mucosal lacerations, consistent with grade 2 esophagitis. The biopsy showed esophagitis with mixed lymphocytic and eosinophilic inflammation and apoptotic component. Pembrolizumab was then stopped pending the results of the biopsy, following the recommendations of the gastroenterologist. Dysphagia, however, remained unchanged. In the meantime, the lenvatinib had to be stopped due to a dental procedure, and the patient noted a marked improvement in her symptoms. After discussion with the gastroenterologist, pembrolizumab was resumed and lenvatinib was suspended. The patient was also started on a PPI twice daily since the first digestive exploration. 1 month later, upper endoscopy showed complete recovery, the patient's symptoms improved, and lenvatinib was resumed. However, symptoms of dysphagia resumed a few days later. Lenvatinib was finally resumed at a reduced dose without reappearance in her symptoms.
We present a case of oesophagitis as a likely complication of lenvatinib for advanced endometrial cancer. The initiation of PPI and dose reduction of the lenvatinib allowed the patient to successfully go back on treatment.
帕博利珠单抗是一种靶向程序性细胞死亡蛋白1（PD-1）的单克隆抗体。它用于多种肿瘤疾病的管理和治疗。仅举几例：难治性和晚期黑色素瘤、非小细胞肺癌（NSCLC）、头颈部鳞状细胞癌（HNSCC）、肾细胞癌和胃癌。它还被批准用于一线化疗失败后的转移性错配修复缺陷（dMMR）子宫内膜癌。乐伐替尼是一种口服多激酶抑制剂，靶向血管内皮生长因子受体1-3、成纤维细胞生长因子受体1-4、血小板衍生生长因子受体-α、RET和KIT。事实证明，乐伐替尼和帕博利珠单抗联合使用比单药治疗更有效。在此，我们报告一例患者，其可能发生了乐伐替尼相关食管炎，据我们所知，这是一种此前文献中未描述的并发症。
病例报告。我们描述了一名65岁的转移性子宫内膜癌女性患者，在接受乐伐替尼联合帕博利珠单抗治疗几个月后出现吞咽困难。上消化道内镜检查结果显示食管上段黏膜非常脆弱，有黏膜撕裂伤，符合2级食管炎。活检显示食管炎伴有混合性淋巴细胞和嗜酸性粒细胞炎症以及凋亡成分。根据胃肠病学家的建议，在活检结果出来之前停用了帕博利珠单抗。然而，吞咽困难症状未改善。与此同时，由于牙科手术停用了乐伐替尼，患者注意到其症状有明显改善。与胃肠病学家讨论后，恢复使用帕博利珠单抗并暂停乐伐替尼。自首次消化检查以来，患者还开始每天服用两次质子泵抑制剂（PPI）。1个月后，上消化道内镜检查显示完全恢复，患者症状改善，恢复使用乐伐替尼。然而，几天后吞咽困难症状再次出现。最终以较低剂量恢复使用乐伐替尼，患者症状未再出现。
我们报告一例食管炎，它可能是晚期子宫内膜癌患者使用乐伐替尼的并发症。使用PPI和减少乐伐替尼剂量使患者能够成功恢复治疗。
