Management of pembrolizumab-induced steroid refractory mucositis with infliximab:A case report

作     者：Harry Dang Jiyuan Sun Guoliang Wang Gregory Renner Lester Layfield Jaffar Hilli 

作者机构：Department of MedicineUniversity of MissouriColumbiaMO 65212United States Department of Hematology-OncologyUniversity of MissouriColumbiaMO 65212United States Department of PathologyUniversity of MissouriColumbiaMO 65212United States Department of Otolaryngology-Head and Neck SurgeryUniversity of MissouriColumbiaMO 65212United States 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2020年第8卷第18期

页      面：4100-4108页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Pembrolizumab Infliximab Mucositis Melanoma Immunotherapy Refractory Case report 

摘      要：BACKGROUND Pembrolizumab is an anti-programmed death receptor 1(PD-1)that was shown to have a tolerable safety profile with 17%of grade 3-4 drug-related adverse events,notable response rate of 16%with median duration of response of 8 mo,and median overall survival of 8 *** mucositis is a very rare complication with only two cases of grade 4 mucositis reported,and both cases had good response to intravenous methylprednisolone and subsequent oral prednisone *** report the first case of pembrolizumab-induced severe mucositis that was refractory to steroid *** SUMMARY An 80-year-old woman with a past medical history of recurrent right cheek nodular melanoma status post resection and new right lung metastatic melanoma on immunotherapy presented with dysphagia and odynophagia for 2 *** initially received 2 doses of ipilimumab 1 year ago with good outcome,but treatment was discontinued after developing severe diarrhea and *** was then initiated 4 mo after disease *** improvement was noted after 3 ***,after 6 cycles of pembrolizumab,patient developed odynophagia and *** of symptoms was noted after discontinuation of pembrolizumab and initiation of steroids.3 mo later,patient developed pharyngeal swelling with hoarseness and new oxygen requirement due to impending airway obstruction while being on prednisone tapering regimen,finally ended up with intubation and *** analysis of left laryngeal and epiglottis tissue showed granulation tissue with acute on chronic inflammation,negative for malignancy and *** achieved marked improvement after 2 doses of infliximab of 5 mg/kg every 2 wk while continuing on prednisone tapering *** We report the first case of pembrolizumab-induced grade 4 mucositis that had limited recovery with prolonged steroid course but had rapid response with addition of *** patient had recurrent mucositis symp