PICTURES IN DIGESTIVE PATHOLOGY

 

Immune mediated colitis caused by lung cancer treatment with atezolizumab

 

 

Santiago González-Vázquez¹, Susana de-la-Riva-Onandía¹, José Ignacio Echeveste² and Miguel Muñoz-Navas¹

Departments of ¹Gastroenterology and ²Pathology. Clínica Universidad de Navarra. Pamplona, Spain

 

 

Introduction

Atezolizumab is an IgG1 isotype monoclonal antibody against the protein programmed cell death-ligand 1 (PD-L1). PD-L1 may be highly expressed in some tumors and is believed to inhibit immune cells that recognize and attack tumor cells. Inhibition of PD-L1 can remove its inhibitory effect and provoke an anti-tumor response.

In October 2016, the Food and Drugs Administration (FDA) approved atezolizumab for the treatment of patients with metastatic non-small cell lung cancer after disease progression during or following platinum based chemotherapy.

 

Case report

We present the case of a 43-year-old male with stage IV lung adenocarcinoma in progression, despite standard chemotherapy. He was participating in a clinical randomized trial with four cycles of chemotherapy as follows: cisplatin, pemetrexed and atezolizumab. He showed a good tolerance.

After the last cycle of chemotherapy, he had bloody diarrhea and fever. Stool cultures were negative. A colonoscopy was performed and a pancolitis with a multiple fibrin-coated ulcer was identified. Numerous glandular crypts with cryptic micro-abscesses and a chronic inflammatory lymphoplasmocytic infiltrate were found on biopsy of the colon. These histological findings are similar to those described in ulcerative colitis.

 

 

 

 

Conclusion

Immune mediated colitis is a possible adverse event that is poorly described. It occurs in 19.7% of all patients receiving atezolizumab and requires the administration of corticosteroids for its resolution.

 

References

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2. De Velasco G, Je Y, Bossé D, et al. Comprehensive meta-analysis of key immune-related adverse events from CTLA-4 and PD-1/PD-L1 inhibitors in cancer patients. Cancer Immunol Res 2017. pii: canimm.0237.2016. DOI: 10.1158/2326-6066.CIR-16-0237.         [ Links ]

3. Nishijima TF, Shachar SS, Nyrop KA, et al. Safety and tolerability of PD-1/PD-L1 inhibitors compared with chemotherapy in patients with advanced cancer: A meta-analysis. Oncologist 2017. pii: theoncologist.2016-0419. DOI: 10.1634/theoncologist.2016-0419.         [ Links ]