Multidisciplinary treatment of a patient with severe immune checkpoint inhibitor-induced colitis:A case report  

作　　者：Lu Lu Li Sha Yu Feng Liang Yan 

机构地区：[1]Department of Gastroenterology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China [2]Department of General Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China

出　　处：《World Journal of Clinical Cases》2022年第35期13108-13114,共7页世界临床病例杂志

基　　金：Shanghai Municipal Health Commission,Shanghai Municipal Administrator of Traditional Chinese Medicine,No.ZY(2021-2023)-0201-02.

摘　　要：BACKGROUND Immune checkpoint inhibitors(ICIs)are a new class of antitumor drugs that have been approved to treat a variety of malignant tumors.However,the occurrence of immune related adverse events(irAEs)has become an important reason for terminating treatment.ICIs sometimes lead to diarrhea and colitis,with severe enterocolitis potentially causing the hemorrhage of the lower gastrointestinal tract and colonic perforation.ICI-associated colitis is primarily treated with glucorticosteroids and/or agents targeting tumor necrosis factor-α.Here,we describe a case of severe ICI-associated colitis due to anti-programmed cell death ligand 1(PD-L1)(durvalumab)treatment for small cell lung cancer with liver metastasis.The patient exhibited a poor response to rescuable therapy,and eventually received a laparoscopic subtotal colectomy and ileostomy.The data presented here will contribute to optimizing current treatment strategies for patients with severe ICI-associated colitis.CASE SUMMARY A 71-year-old man was admitted for a second course of anti-PD-L1+IP(durvalumab+irinotecan+cisplatin)treatment to manage lung cancer with liver metastasis,diagnosed 1 mo previously.Four days after the second dose,the patient developed abdominal pain and bloody diarrhea.Due to the anti-PD-L1 medication history and colonoscopy findings of the patient,he was diagnosed with a colitis associated with ICI treatment.After treatment with sufficient glucocorticoids and two courses of infliximab,the patient developed severe lower gastrointestinal bleeding.After adequate assessment,the patient was treated by laparoscopic surgery,and was discharged in stable condition.CONCLUSION The early screening and hierarchical management of irAEs need the joint participation of a multidisciplinary team.For ICI-related colitis with ineffective medical treatment,timely surgical intervention could prevent the death of patients.

关 键 词：Immune checkpoint inhibitor COLITIS Programmed cell death ligand 1 INFLIXIMAB Laparoscopic surgery Case report 

分 类 号：R574.62[医药卫生—消化系统]