Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan.
Clin J Gastroenterol. 2024 Jun;17(3):523-529. doi: 10.1007/s12328-024-01947-6. Epub 2024 Mar 21.
Atezolizumab is an immune checkpoint inhibitor specific for the programmed death-1 (PD-1) receptor. In this case report, we describe two cases of oral mucositis that developed following the initiation of a systemic chemotherapy regimen comprising atezolizumab and bevacizumab for recurrent hepatocellular carcinoma. After 2 or 3 cycles of treatment, each patient presented with mucosal ulcers in the mouth, oral pain, difficulty in speech and oral intake, and both were admitted to our hospital for management. Following rule out of other conditions such as pharyngeal ulcers, herpetic mucositis, denture or oral trauma, or necrotizing mucositis, both patients were diagnosed with oral mucositis as a severe immune-related adverse event. Oral candidiasis was observed in both cases and should be considered a risk factor for the development of oral mucositis. Chemotherapy was discontinued and treatment with prednisolone was started, along with supportive care. The oral mucositis improved, and prednisolone was gradually reduced; however, in one patient, discontinuation of chemotherapy led to a recurrence of hepatocellular carcinoma. The other patient was lost to follow-up. In patients with risk factors, attention must be paid to the development of oral mucositis during immune checkpoint inhibitor treatment.
阿替利珠单抗是一种针对程序性死亡受体 1（PD-1）的免疫检查点抑制剂。在本病例报告中，我们描述了两例因复发肝细胞癌接受阿替利珠单抗联合贝伐珠单抗全身化疗后出现口腔黏膜炎的病例。治疗 2 或 3 个周期后，每位患者口腔均出现黏膜溃疡、口腔疼痛、言语和进食困难，并收入我院治疗。排除了其他情况（如咽溃疡、疱疹性黏膜炎、义齿或口腔创伤或坏死性黏膜炎）后，均诊断为严重免疫相关不良事件导致的口腔黏膜炎。两例患者均观察到口腔念珠菌病，应将其视为口腔黏膜炎发生的危险因素。停止化疗并开始使用泼尼松龙治疗，同时给予支持治疗。口腔黏膜炎改善，泼尼松龙逐渐减量；然而，其中一位患者因停止化疗导致肝细胞癌复发。另一位患者失访。对于有危险因素的患者，在接受免疫检查点抑制剂治疗期间必须注意口腔黏膜炎的发生。
