Honma Shusaku, Watanabe Satoshi, Nakajima Sanae
Surgery, Kobe City Medical Center West Hospital, Kobe, JPN.
Gastroenterology, Kobe City Medical Center West Hospital, Kobe, JPN.
Cureus. 2024 Aug 8;16(8):e66425. doi: 10.7759/cureus.66425. eCollection 2024 Aug.
Pembrolizumab is widely used to treat various malignant tumors, including gastric cancer; however, it is associated with immune-related adverse events. Among these adverse events, immune-related sclerosing cholangitis (irSC) is a rare type induced by pembrolizumab, and much remains unknown regarding its clinicopathological features and ideal management. Herein, we report the case of a 67-year-old man who received pembrolizumab for postoperative lymph node recurrence of gastric cancer. He developed irSC after the 15th course of pembrolizumab monotherapy, which was diagnosed using radiological imaging and liver biopsy. The patient was successfully treated with prednisolone. Eight months after the onset of irSC, the dose of prednisolone was tapered, and computed tomography revealed that the treatment response to pembrolizumab was maintained with progression-free lymph node metastasis despite not receiving any anticancer treatment. Understanding the characteristic imaging findings and clinicopathological features of irSC is crucial. Further accumulation of cases is necessary to establish the optimal management of irSC and to identify biomarkers that predict its risk.
帕博利珠单抗被广泛用于治疗包括胃癌在内的各种恶性肿瘤；然而，它与免疫相关不良事件有关。在这些不良事件中，免疫相关硬化性胆管炎（irSC）是由帕博利珠单抗诱发的一种罕见类型，关于其临床病理特征和理想的治疗方法仍有许多未知之处。在此，我们报告一例67岁男性患者，他因胃癌术后淋巴结复发接受了帕博利珠单抗治疗。在第15个疗程的帕博利珠单抗单药治疗后，他出现了irSC，通过放射影像学和肝脏活检确诊。该患者接受泼尼松龙治疗成功。irSC发病8个月后，泼尼松龙剂量逐渐减少，计算机断层扫描显示，尽管未接受任何抗癌治疗，但无进展性淋巴结转移，对帕博利珠单抗的治疗反应得以维持。了解irSC的特征性影像学表现和临床病理特征至关重要。需要进一步积累病例，以确立irSC的最佳治疗方法，并识别预测其风险的生物标志物。
