BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic f...BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a particularly serious kind of liver cancer.Liver cancer ranks third in terms of mortality rate worldwide,putting it among the leading causes of deaths from cancer.HCC is the...BACKGROUND Hepatocellular carcinoma(HCC)is a particularly serious kind of liver cancer.Liver cancer ranks third in terms of mortality rate worldwide,putting it among the leading causes of deaths from cancer.HCC is the primary kind of liver cancer and makes up the vast majority of cases,accounting for approximately 90%of occurrences.Numerous research have verified this information.the progress of fatty liver,alcohol induced cirrhosis,smoking habits,obesity caused by overweight,and metabolic diseases such as diabetes.The treatment strategies for HCC can be divided into two categories:One is curative treatment,including liver transplantation,surgical resection,and ablation therapy or selective arterial radiation embolization,aimed at completely eliminating the lesion;Another type is non curative treatment options,including transarterial chemoembolization and systemic therapy,which focus on controlling disease progression and prolonging patient survival.The majority of HCC patients are found to be in an advanced stage and need systemic therapy.Sorafenib and lenvatinib are frequently used as first-line medications in traditional HCC treatment to slow the disease's progression.For second-line treatment,regorafenib,cabozantinib,or remdesizumab are used to inhibit tumors through different mechanisms and prolong survival.In recent years,with the in-depth exploration of the pathogenesis and progression mechanism of HCC,as well as the rapid progress within the domain of tumor immunotherapy,the treatment prospects for advanced HCC patients have shown a positive transformation.This transformation is reflected in the fact that more and more patients are gradually gaining significant and considerable therapeutic advantages from advanced immunotherapy regimens,bringing unprecedented improvements to their treatment outcomes.In order to enable activated T cells to attack tumor cells,immune checkpoint inhibitors interfere with the inhibitory.AIM To evaluate the effects of nivolumab in combination with cabozantinib on patient tumor markers and immune function,as well as the therapeutic efficacy of this combination in treating advanced HCC,a study was conducted.METHODS In all,100 patients with advanced HCC who were brought to our hospital between July 2022 and July 2023 and who did not match the requirements for surgical resection had their clinical data thoroughly analyzed retrospectively in this study.Among them,half of the patients(50 cases)only received oral cabozantinib as a single treatment regimen(set as the control group),while the other half of the patients(50 cases)received intravenous infusion of nivolumab in addition to oral cabozantinib(set as the observation group).The objective of the probe is to examine the variations in disease control rate(DCR)and objective response rate(ORR)between two groups;At the same time,changes in the levels of T lymphocyte subsets(CD3+,CD4+,CD8+)and tumor markers,including AFP,GP-73,and AFP-L3,were evaluated;In addition,changes in liver and kidney function indicators and adverse reactions during treatment were also monitored.For patients with advanced HCC,this research also calculated and analyzed the progression free survival of two patient groups throughout the course of a 12-month follow-up to assess the effectiveness and safety of this therapeutic approach.RESULTS Upon comparing baseline information for both groups of subjects before treatment,it was found that no statistically significant alterations had occurred(P>0.05).After the therapeutic intervention,the observation group and control group's ORR and DCR differed statistically significantly(P<0.05).The observation group's scores significantly improved.Subsequent examination revealed that the observation group's T lymphocyte subset levels had significantly changed,mostly exhibiting an increase in CD3+,CD4+,and CD4+/CD8+levels while CD8+levels had comparatively dropped.There was a significant difference(P<0.05)between these changes and those in the control group.The observation group also showed positive improvements in tumor markers;AFP,GP-73,and AFP-L3 levels were considerably lower in the group under observation than in the control group,with statistically significant differences(P<0.05).When liver function was assessed,total bilirubin and alanine aminotransferase were found to be considerably lower in the observation group than in the control group(P<0.05).The incidence of adverse responses was not statistically significant(P>0.05),indicating that the incidence of adverse responses did not differ significantly between the two groups.CONCLUSION When treating advanced HCC,nivolumab and cabozantinib together have the ability to increase T lymphocyte numbers,reduce tumor marker levels,effectively prolong survival time,and have better efficacy than simple control treatment,with good safety.展开更多
Skin reaction or dermatological toxicities induced by immunotherapy is common.It usually manifests skin rash or erythema and can be cured by skin lotion or steroid.Nivolumab,a human IgG4 programmed cell death protein ...Skin reaction or dermatological toxicities induced by immunotherapy is common.It usually manifests skin rash or erythema and can be cured by skin lotion or steroid.Nivolumab,a human IgG4 programmed cell death protein 1(PD-1)inhibitor,blocks T cells activation preventing signal and allows the immune system to clear cancer cells.Nivolumab was approved in the second-line therapy in squamous cell lung cancer by FDA,with less than 10%unusual skin reaction,like sensory neuropathy,peeling skin,erythema multiforme,vitiligo,and psoriasis.Radiotherapy could aggravate this skin reaction through inflammatory response and promotion of immunity.The combined treatment of anti-PD-1 and radiotherapy represented a new promising therapeutic approach in many studies,but the risk of side effects may be high.We reported a patient with advanced squamous cell lung cancer who suffered from serious skin immune-related adverse events when he was treated with nivolumab and radiotherapy.The immune overreaction of the treatment of anti-PD-1 treatment and radiotherapy might cause these serious skin adverse events.Our report warranted careful workup to reduce the risk of side effects by combinative therapy with anti-PD-1 and radiotherapy.展开更多
BACKGROUND Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients.Little is known about the intestinal nonpathogenic bacterial composition of hepatocellular carcinoma(HCC)patients treate...BACKGROUND Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients.Little is known about the intestinal nonpathogenic bacterial composition of hepatocellular carcinoma(HCC)patients treated by immunotherapy.AIM To determine whether there is a correlation between gut bacterial composition and prognosis in HCC patients.METHODS From September 2019 to March 2020,we prospectively collected fecal samples and examined the gut microbiome of 8 advanced HCC patients treated with nivolumab as a second-or third-line systemic treatment.Fecal samples were collected before the start of immunotherapy.Fecal samples of patients with progression during treatment were collected at the time of progression,and fecal samples of patients who showed good response to nivolumab were collected after 5-7 mo as follow-up.Metagenomic data from 16S ribosomal RNA sequencing were analyzed using CLC Genomics Workbench.Microbiome data were analyzed according to therapeutic response.RESULTS All 8 patients were male,of which 6 had underlying chronic hepatitis B.A higher Shannon index was found in the responders than in the non-responders after nivolumab therapy(P=0.036).The unweighted beta diversity analysis also showed that the overall bacterial community structure and phylogenetic diversity were clearly distinguished according to therapeutic response.There was no significant difference in the diversity or composition of the patient gut microbiome according to the immunotherapy used.Several taxa specific to therapeutic response were designated as follows:Dialister pneumosintes,Escherichia coli,Lactobacillus reteri,Streptococcus mutans,Enterococcus faecium,Streptococcus gordonii,Veillonella atypica,Granulicatella sp.,and Trchuris trichiura for the nonresponders;Citrobacter freundii,Azospirillum sp.and Enterococcus durans for the responders.Of note,a skewed Firmicutes/Bacteroidetes ratio and a low Prevotella/Bacteroides ratio can serve as predictive markers of non-response,whereas the presence of Akkermansia species predicts a good response.CONCLUSION The current presumptive study suggests a potential role for the gut microbiome as a prognostic marker for the response to nivolumab in treatment of HCC patients.展开更多
BACKGROUND Sarcomatoid hepatocellular carcinoma(SHC)is a rare subtype of hepatocellular carcinoma(HCC),with a high recurrence rate after surgery.In addition to limited effective treatment for the advanced stage of SHC...BACKGROUND Sarcomatoid hepatocellular carcinoma(SHC)is a rare subtype of hepatocellular carcinoma(HCC),with a high recurrence rate after surgery.In addition to limited effective treatment for the advanced stage of SHC,the prognosis of patients with this malignancy is worse than that of patients with conventional HCC.CASE SUMMARY We present the case of a 54-year-old man with SHC who underwent radical segmental hepatectomy,which relapsed 4 mo after surgery due to lymphatic metastasis in the porta hepatis.Although a second surgery was performed,new metastasis developed in the mediastinal lymph nodes.Therefore,sorafenib and lenvatinib were sequentially administered as first-and second-line systemic therapies,respectively.However,progressive disease was confirmed based on a recurrent hepatic lesion and new metastatic lesion in the abdominal cavity.Percutaneous transhepatic cholangial drainage was performed to alleviate the biliary obstruction.Because the tumor was strongly positive for programmed death-ligand 1,the patient was started on nivolumab.Imaging studies revealed that after two cycles of immunotherapy,the metastatic lesions decreased to undetectable levels.CONCLUSION The patient experienced continuous complete remission for 8 mo.Immune checkpoint inhibitors are useful for the treatment of advanced SHC.展开更多
BACKGROUND Immune checkpoint inhibitors are widely used for treatment of many advanced malignancies.Lower gastrointestinal(GI)side effects,such as diarrhea and colitis,are common,but upper GI side effects are rarely r...BACKGROUND Immune checkpoint inhibitors are widely used for treatment of many advanced malignancies.Lower gastrointestinal(GI)side effects,such as diarrhea and colitis,are common,but upper GI side effects are rarely reported.Consequently,the correct treatment of upper GI adverse events has been less frequently described.CASE SUMMARY We describe a case of a 16-year-old woman with stage IIIb malignant melanoma treated with adjuvant monotherapy using Nivolumab.The patient developed severe gastritis after six series of Nivolumab with weight loss,nausea,and vomiting.There was no effect of intravenous steroids,but the patient′s condition resolved after administration of Infliximab.CONCLUSION This case report supports the same treatment for gastritis as for colitis,which is in line with current guidelines.展开更多
BACKGROUND Checkpoint-Inhibition has revolutionized the treatment for several entities such as melanoma and renal cell carcinoma.The first encouraging experience in ovarian cancer was reported for nivolumab,a fully hu...BACKGROUND Checkpoint-Inhibition has revolutionized the treatment for several entities such as melanoma and renal cell carcinoma.The first encouraging experience in ovarian cancer was reported for nivolumab,a fully humanized anti-programmed death-1 antibody.Pseudoprogression is a new phenomenon associated with these novel immuno-oncologic agents.It can be explained by infiltrating leucocytes and edema that result in a temporary increase in tumor size and delayed subsequent shrinkage due to tumor cell destruction.CASE SUMMARY We report on a 47-year old patient with platinum-resistant ovarian cancer that was treated off-label with nivolumab 3mg/kg iv d1q14d.She first experienced classic pseudoprogression with inguinal lymph node swelling after cycle two and subsequent shrinkage.After 6 cycles she presented with rectal bleeding and progressive disease was diagnosed due to new tumor infiltration into the rectum.CONCLUSION Clinicians should be aware of pseudoprogression,its underlying mechanisms and strategies to discriminate pseudo-from real progression in ovarian cancer.展开更多
BACKGROUND Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events,the management of which can be challenging...BACKGROUND Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events,the management of which can be challenging due to its mimicry of other autoimmune related disorders such as immunoglobulin G4(IgG4)related disease when the pancreaticobiliary system is affected.Nivolumab,an IgG4 monoclonal antibody,has been associated with cholangitis and pancreatitis,however its association with IgG4 related disease has not been reported to date.CASE SUMMARY We present a case of immune-related pancreatitis and cholangiopathy in a patient who completed treatment with nivolumab for anal squamous cell carcinoma.Patients IgG4 levels was normal on presentation.She responded to steroids but due to concerns for malignant biliary stricture,she opted for surgery,the pathology of which suggested IgG4 related disease.CONCLUSION We hypothesize this case of IgG4 related cholangitis and pancreatitis was likely triggered by nivolumab.展开更多
BACKGROUND A variety of immune-modulating drugs are becoming increasingly used for various cancers. Despite increasing indications and improved efficacy, they are often associated with a wide variety of immune mediate...BACKGROUND A variety of immune-modulating drugs are becoming increasingly used for various cancers. Despite increasing indications and improved efficacy, they are often associated with a wide variety of immune mediated adverse events including colitis that may be refractory to conventional therapy. Although these drugs are being more commonly used by Hematologists and Oncologists, there are still many gastroenterologists who are not familiar with the incidence and natural history of gastrointestinal immune-mediated side effects, as well as the role of infliximab in the management of this condition.CASE SUMMARY We report a case of a 63-year-old male with a history of metastatic renal cell carcinoma who presented to our hospital with severe diarrhea. The patient had received his third combination infusion of the anti-CTLA-4 monoclonal antibody Ipilimumab and the immune checkpoint inhibitor Nivolumab and developed severe watery non-bloody diarrhea the same day. He presented to the hospital where he was found to be severely dehydrated and in acute renal failure. An extensive workup was negative for infectious etiologies and he was initiated on high dose intravenous steroids. However, he continued to worsen. A colonoscopy was performed and revealed no endoscopic evidence of inflammation. Random biopsies for histology were obtained which showed mild colitis, and were negative for Cytomegalovirus and Herpes Simplex Virus. He was diagnosed with severe steroid-refractory colitis induced by Ipilimumab and Nivolumab and was initiated on Infliximab. He responded promptly to it and his diarrhea resolved the next day with progressive resolution of his renal impairment. On follow up his gastrointestinal side symptoms did not recur.CONCLUSION Given the increasing use of immune therapy in a variety of cancers, it is important for gastroenterologists to be familiar with their gastrointestinal side effects and comfortable with their management, including prescribing infliximab.展开更多
文摘BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a particularly serious kind of liver cancer.Liver cancer ranks third in terms of mortality rate worldwide,putting it among the leading causes of deaths from cancer.HCC is the primary kind of liver cancer and makes up the vast majority of cases,accounting for approximately 90%of occurrences.Numerous research have verified this information.the progress of fatty liver,alcohol induced cirrhosis,smoking habits,obesity caused by overweight,and metabolic diseases such as diabetes.The treatment strategies for HCC can be divided into two categories:One is curative treatment,including liver transplantation,surgical resection,and ablation therapy or selective arterial radiation embolization,aimed at completely eliminating the lesion;Another type is non curative treatment options,including transarterial chemoembolization and systemic therapy,which focus on controlling disease progression and prolonging patient survival.The majority of HCC patients are found to be in an advanced stage and need systemic therapy.Sorafenib and lenvatinib are frequently used as first-line medications in traditional HCC treatment to slow the disease's progression.For second-line treatment,regorafenib,cabozantinib,or remdesizumab are used to inhibit tumors through different mechanisms and prolong survival.In recent years,with the in-depth exploration of the pathogenesis and progression mechanism of HCC,as well as the rapid progress within the domain of tumor immunotherapy,the treatment prospects for advanced HCC patients have shown a positive transformation.This transformation is reflected in the fact that more and more patients are gradually gaining significant and considerable therapeutic advantages from advanced immunotherapy regimens,bringing unprecedented improvements to their treatment outcomes.In order to enable activated T cells to attack tumor cells,immune checkpoint inhibitors interfere with the inhibitory.AIM To evaluate the effects of nivolumab in combination with cabozantinib on patient tumor markers and immune function,as well as the therapeutic efficacy of this combination in treating advanced HCC,a study was conducted.METHODS In all,100 patients with advanced HCC who were brought to our hospital between July 2022 and July 2023 and who did not match the requirements for surgical resection had their clinical data thoroughly analyzed retrospectively in this study.Among them,half of the patients(50 cases)only received oral cabozantinib as a single treatment regimen(set as the control group),while the other half of the patients(50 cases)received intravenous infusion of nivolumab in addition to oral cabozantinib(set as the observation group).The objective of the probe is to examine the variations in disease control rate(DCR)and objective response rate(ORR)between two groups;At the same time,changes in the levels of T lymphocyte subsets(CD3+,CD4+,CD8+)and tumor markers,including AFP,GP-73,and AFP-L3,were evaluated;In addition,changes in liver and kidney function indicators and adverse reactions during treatment were also monitored.For patients with advanced HCC,this research also calculated and analyzed the progression free survival of two patient groups throughout the course of a 12-month follow-up to assess the effectiveness and safety of this therapeutic approach.RESULTS Upon comparing baseline information for both groups of subjects before treatment,it was found that no statistically significant alterations had occurred(P>0.05).After the therapeutic intervention,the observation group and control group's ORR and DCR differed statistically significantly(P<0.05).The observation group's scores significantly improved.Subsequent examination revealed that the observation group's T lymphocyte subset levels had significantly changed,mostly exhibiting an increase in CD3+,CD4+,and CD4+/CD8+levels while CD8+levels had comparatively dropped.There was a significant difference(P<0.05)between these changes and those in the control group.The observation group also showed positive improvements in tumor markers;AFP,GP-73,and AFP-L3 levels were considerably lower in the group under observation than in the control group,with statistically significant differences(P<0.05).When liver function was assessed,total bilirubin and alanine aminotransferase were found to be considerably lower in the observation group than in the control group(P<0.05).The incidence of adverse responses was not statistically significant(P>0.05),indicating that the incidence of adverse responses did not differ significantly between the two groups.CONCLUSION When treating advanced HCC,nivolumab and cabozantinib together have the ability to increase T lymphocyte numbers,reduce tumor marker levels,effectively prolong survival time,and have better efficacy than simple control treatment,with good safety.
文摘免疫检查点抑制剂(immune checkpoint inhibitors,ICI)是肿瘤免疫治疗的最新药物及重要手段之一。免疫检查点的功能是保持自身耐受并防止自身免疫。ICI通过阻断免疫系统中的抑制性信号通路,重新激活并促进机体对肿瘤的免疫应答,起到杀伤肿瘤细胞的作用。细胞毒性T淋巴细胞相关抗原4(cytotoxic T lymphocyte antigen-4,CTLA-4)抑制剂是首个广泛应用于临床的ICI,近年来程序性死亡受体1(programmed cell death protein-1,PD-1)抑制剂Nivolumab(纳武利尤单抗)、Pembrolizumab及程序性死亡配体1(programmed death ligand 1,PD-L1)抑制剂Atezolizumab、Avelumab和Durvalumab等ICI逐渐应用于治疗黑色素瘤、肺非小细胞肺癌(non-small cell lung cancer,NSCLC)和转移性肾癌等不同类型的肿瘤[1]。
文摘Skin reaction or dermatological toxicities induced by immunotherapy is common.It usually manifests skin rash or erythema and can be cured by skin lotion or steroid.Nivolumab,a human IgG4 programmed cell death protein 1(PD-1)inhibitor,blocks T cells activation preventing signal and allows the immune system to clear cancer cells.Nivolumab was approved in the second-line therapy in squamous cell lung cancer by FDA,with less than 10%unusual skin reaction,like sensory neuropathy,peeling skin,erythema multiforme,vitiligo,and psoriasis.Radiotherapy could aggravate this skin reaction through inflammatory response and promotion of immunity.The combined treatment of anti-PD-1 and radiotherapy represented a new promising therapeutic approach in many studies,but the risk of side effects may be high.We reported a patient with advanced squamous cell lung cancer who suffered from serious skin immune-related adverse events when he was treated with nivolumab and radiotherapy.The immune overreaction of the treatment of anti-PD-1 treatment and radiotherapy might cause these serious skin adverse events.Our report warranted careful workup to reduce the risk of side effects by combinative therapy with anti-PD-1 and radiotherapy.
文摘BACKGROUND Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients.Little is known about the intestinal nonpathogenic bacterial composition of hepatocellular carcinoma(HCC)patients treated by immunotherapy.AIM To determine whether there is a correlation between gut bacterial composition and prognosis in HCC patients.METHODS From September 2019 to March 2020,we prospectively collected fecal samples and examined the gut microbiome of 8 advanced HCC patients treated with nivolumab as a second-or third-line systemic treatment.Fecal samples were collected before the start of immunotherapy.Fecal samples of patients with progression during treatment were collected at the time of progression,and fecal samples of patients who showed good response to nivolumab were collected after 5-7 mo as follow-up.Metagenomic data from 16S ribosomal RNA sequencing were analyzed using CLC Genomics Workbench.Microbiome data were analyzed according to therapeutic response.RESULTS All 8 patients were male,of which 6 had underlying chronic hepatitis B.A higher Shannon index was found in the responders than in the non-responders after nivolumab therapy(P=0.036).The unweighted beta diversity analysis also showed that the overall bacterial community structure and phylogenetic diversity were clearly distinguished according to therapeutic response.There was no significant difference in the diversity or composition of the patient gut microbiome according to the immunotherapy used.Several taxa specific to therapeutic response were designated as follows:Dialister pneumosintes,Escherichia coli,Lactobacillus reteri,Streptococcus mutans,Enterococcus faecium,Streptococcus gordonii,Veillonella atypica,Granulicatella sp.,and Trchuris trichiura for the nonresponders;Citrobacter freundii,Azospirillum sp.and Enterococcus durans for the responders.Of note,a skewed Firmicutes/Bacteroidetes ratio and a low Prevotella/Bacteroides ratio can serve as predictive markers of non-response,whereas the presence of Akkermansia species predicts a good response.CONCLUSION The current presumptive study suggests a potential role for the gut microbiome as a prognostic marker for the response to nivolumab in treatment of HCC patients.
基金The National 13th Five-Year Science and Technology Plan Major Projects of China,No.2017ZX10203205-006-001.
文摘BACKGROUND Sarcomatoid hepatocellular carcinoma(SHC)is a rare subtype of hepatocellular carcinoma(HCC),with a high recurrence rate after surgery.In addition to limited effective treatment for the advanced stage of SHC,the prognosis of patients with this malignancy is worse than that of patients with conventional HCC.CASE SUMMARY We present the case of a 54-year-old man with SHC who underwent radical segmental hepatectomy,which relapsed 4 mo after surgery due to lymphatic metastasis in the porta hepatis.Although a second surgery was performed,new metastasis developed in the mediastinal lymph nodes.Therefore,sorafenib and lenvatinib were sequentially administered as first-and second-line systemic therapies,respectively.However,progressive disease was confirmed based on a recurrent hepatic lesion and new metastatic lesion in the abdominal cavity.Percutaneous transhepatic cholangial drainage was performed to alleviate the biliary obstruction.Because the tumor was strongly positive for programmed death-ligand 1,the patient was started on nivolumab.Imaging studies revealed that after two cycles of immunotherapy,the metastatic lesions decreased to undetectable levels.CONCLUSION The patient experienced continuous complete remission for 8 mo.Immune checkpoint inhibitors are useful for the treatment of advanced SHC.
文摘BACKGROUND Immune checkpoint inhibitors are widely used for treatment of many advanced malignancies.Lower gastrointestinal(GI)side effects,such as diarrhea and colitis,are common,but upper GI side effects are rarely reported.Consequently,the correct treatment of upper GI adverse events has been less frequently described.CASE SUMMARY We describe a case of a 16-year-old woman with stage IIIb malignant melanoma treated with adjuvant monotherapy using Nivolumab.The patient developed severe gastritis after six series of Nivolumab with weight loss,nausea,and vomiting.There was no effect of intravenous steroids,but the patient′s condition resolved after administration of Infliximab.CONCLUSION This case report supports the same treatment for gastritis as for colitis,which is in line with current guidelines.
文摘BACKGROUND Checkpoint-Inhibition has revolutionized the treatment for several entities such as melanoma and renal cell carcinoma.The first encouraging experience in ovarian cancer was reported for nivolumab,a fully humanized anti-programmed death-1 antibody.Pseudoprogression is a new phenomenon associated with these novel immuno-oncologic agents.It can be explained by infiltrating leucocytes and edema that result in a temporary increase in tumor size and delayed subsequent shrinkage due to tumor cell destruction.CASE SUMMARY We report on a 47-year old patient with platinum-resistant ovarian cancer that was treated off-label with nivolumab 3mg/kg iv d1q14d.She first experienced classic pseudoprogression with inguinal lymph node swelling after cycle two and subsequent shrinkage.After 6 cycles she presented with rectal bleeding and progressive disease was diagnosed due to new tumor infiltration into the rectum.CONCLUSION Clinicians should be aware of pseudoprogression,its underlying mechanisms and strategies to discriminate pseudo-from real progression in ovarian cancer.
文摘BACKGROUND Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events,the management of which can be challenging due to its mimicry of other autoimmune related disorders such as immunoglobulin G4(IgG4)related disease when the pancreaticobiliary system is affected.Nivolumab,an IgG4 monoclonal antibody,has been associated with cholangitis and pancreatitis,however its association with IgG4 related disease has not been reported to date.CASE SUMMARY We present a case of immune-related pancreatitis and cholangiopathy in a patient who completed treatment with nivolumab for anal squamous cell carcinoma.Patients IgG4 levels was normal on presentation.She responded to steroids but due to concerns for malignant biliary stricture,she opted for surgery,the pathology of which suggested IgG4 related disease.CONCLUSION We hypothesize this case of IgG4 related cholangitis and pancreatitis was likely triggered by nivolumab.
文摘BACKGROUND A variety of immune-modulating drugs are becoming increasingly used for various cancers. Despite increasing indications and improved efficacy, they are often associated with a wide variety of immune mediated adverse events including colitis that may be refractory to conventional therapy. Although these drugs are being more commonly used by Hematologists and Oncologists, there are still many gastroenterologists who are not familiar with the incidence and natural history of gastrointestinal immune-mediated side effects, as well as the role of infliximab in the management of this condition.CASE SUMMARY We report a case of a 63-year-old male with a history of metastatic renal cell carcinoma who presented to our hospital with severe diarrhea. The patient had received his third combination infusion of the anti-CTLA-4 monoclonal antibody Ipilimumab and the immune checkpoint inhibitor Nivolumab and developed severe watery non-bloody diarrhea the same day. He presented to the hospital where he was found to be severely dehydrated and in acute renal failure. An extensive workup was negative for infectious etiologies and he was initiated on high dose intravenous steroids. However, he continued to worsen. A colonoscopy was performed and revealed no endoscopic evidence of inflammation. Random biopsies for histology were obtained which showed mild colitis, and were negative for Cytomegalovirus and Herpes Simplex Virus. He was diagnosed with severe steroid-refractory colitis induced by Ipilimumab and Nivolumab and was initiated on Infliximab. He responded promptly to it and his diarrhea resolved the next day with progressive resolution of his renal impairment. On follow up his gastrointestinal side symptoms did not recur.CONCLUSION Given the increasing use of immune therapy in a variety of cancers, it is important for gastroenterologists to be familiar with their gastrointestinal side effects and comfortable with their management, including prescribing infliximab.
