Abstract
A 71-year-old Japanese man was treated with 200 mg of pembrolizumab for lung adenocarcinoma with multiple bone metastases at the Department of Respiratory Medicine of Kameda General Hospital. After 19 treatment courses, he complained of epigastric pain before meals. Upper gastrointestinal endoscopy showed multiple erosions in the gastric antrum, and antacids were administered at follow-up. After 27 treatment courses, the patient underwent another endoscopy because of anorexia. The erosions were enlarged and had increased from the gastric antrum to the greater curvature of the body. Histological biopsy showed lymphocytic infiltration with a predominance of CD8-positive T cells. The patient had previously been treated for Helicobacter pylori infection, and we suspected drug-induced gastritis due to the administration of immune checkpoint inhibitors in the course of the disease. Pembrolizumab was discontinued, and the patient’s symptoms gradually improved. Endoscopic examinations were performed 2, 5, and 9 months after discontinuation of pembrolizumab, and improvement in mucosal findings and decreased lymphocyte infiltration were confirmed each time. The patient has remained without any relapse of symptoms for more than 1 year after discontinuing treatment.
Highlights
Immune checkpoint inhibitors (ICIs) are widely used in the treatment of various cancers, including gastric and esophageal cancers
A 71-year-old Japanese man with un-resectable advanced lung adenocarcinoma was started on a once-every-threeweek regimen of 200 mg pembrolizumab, a programmed cell death 1 (PD-1) inhibitor, at the Department of Pulmonary Medicine in our hospital in 2019
In cancer treatment with ICI, immunerelated adverse events (irAEs) are a potential cause of concern for many patients and clinicians
Summary
Immune checkpoint inhibitors (ICIs) are widely used in the treatment of various cancers, including gastric and esophageal cancers. We report the temporal changes in symptoms, affected sites, and endoscopic findings of gastritis after ICI administration through comparison with previous case reports. Endoscopic observation of the stomach was performed 2, 5, and 9 months after discontinuation of pembrolizumab, and improvement in gastric mucosal findings was confirmed.
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