Reactions 1704, p206 - 2 Jun 2018 Acute inflammatory enterocolitis: case report An 18-year-old man developed acute inflammatory enterocolitis during treatment with ipilimumab for metastatic melanoma [route not stated]. The man, who had been diagnosed with metastatic amelanotic melanoma, was started on first-line therapy with ipilimumab 3 mg/kg plus nivolumab 1 mg/kg every three weeks. He tolerated the treatment well; however, he developed mild hepatitis. The hepatitis was characterised by grade 2 transaminase elevation. After four weeks of methylprednisolone treatment, the hepatitis resolved. After four doses of combination therapy, the metastases decreased and he was started on maintenance therapy with nivolumab 3 mg/kg every second week. After two doses, the underlying disease was progressed. He underwent adjuvant radiotherapy and was started on high-dose ipilimumab 10 mg/kg every three weeks. Five days after the second dose of ipilimumab, he presented with abdominal pain, nausea, loss of appetite, weight loss and vomiting. Therefore, he was hospitalised and was started on IV fluid replacement. CT scans showed a pronounced thickening of the ileum and jejunum walls with contrast enhancement, which was consistent with an inflammatory process. Therefore, he was treated with methylprednisolone along with parenteral fluids and nutrition. In spite of these treatments, his condition worsened with persistent vomiting, nausea, weight loss and abdominal pain. One week later, he developed severe diarrhoea. Repeated CT scans showed an extension of the inflammatory changes to the transversing and ascending colon. Punch biopsies taken from the ileum, duodenum and colon revealed a lymphoplasmocytic infiltration of the lamina propria and intraepithelial neutrophilic granulocytes (cryptitis, crypt abscesses), which confirmed a diagnosis of a severe acute inflammatory enterocolitis-induced by high-dose ipilimumab. He developed radiographic and clinical signs of paralytic ileus with large intraluminal fluid retentions and reduced bowel motility due to the prolonged severe inflammation. The man’s condition improved slowly after the administration of three doses of infliximab 5 mg/kg along with high-dose corticosteroids. After seven weeks of hospitalisation, he was discharged on methylprednisolone with 10kg less weight loss. Six months later, he was well and free of disease without further adjuvant therapy. Author comment: "Thus, the high toxicity observed in the reported case is most likely attributable to the high ipilimumab dose of 10 mg/kg.""Herein, we report on a young patient who developed a severe, life-threatening gastrointestinal toxicity to high-dose ipilimumab." Olischewsky A, et al. Dose-dependent toxicity of ipilimumab in metastatic melanoma. European Journal of Cancer 95: 104-108, May 2018. Available from: URL: http://doi.org/10.1016/j.ejca.2018.01.088 - Germany 803323341 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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