METHODS: A 76-year-old woman treated with ipilimumab for metastatic melanoma presented with abdominal pain, vomiting, and diarrhea for at least the previous 4 days. Laboratory tests, among others, revealed elevated aminotransferases and C-reactive protein. During hospitalization, the patient also developed fever.
METHODS: The patient, after excluding alternative causes of aminotransferase elevation, was diagnosed with grade 3 ipilimumab-associated hepatotoxicity.
METHODS: Budesonide monotherapy was administered; initial daily dose was 12 mg.
RESULTS: Fever subsided after the first dose of budesonide. Aminotransferases returned to normal-near normal approximately 1 month after the first dose of budesonide. After this point, daily dose was reduced by 3 mg every 2 weeks, with no clinical or biochemical relapse.
CONCLUSIONS: This case of ICPI hepatitis is, to our knowledge, the first in the literature managed with budesonide monotherapy. Therefore, budesonide may be a potentially attractive option for the management of ICPI-associated liver injury in cases where corticosteroid treatment is necessary due to its safety profile and the potential advantage of faster immunotherapy rechallenge in selected patients without requiring dose tapering, in contrast to systemically acting corticosteroids. Clinical trials should be conducted in the future in order to validate or refute these findings.
方法:一名76岁女性接受伊匹单抗治疗转移性黑色素瘤伴腹痛,呕吐,和腹泻至少前4天。实验室测试,其中,显示转氨酶和C反应蛋白升高。住院期间,病人也出现发烧。
方法:患者,在排除转氨酶升高的替代原因后,被诊断为3级ipilimumab相关肝毒性。
方法:布地奈德单药治疗;初始日剂量为12mg。
结果:首次服用布地奈德后发热消退。首次服用布地奈德后约1个月,氨基转移酶恢复正常-接近正常。在这之后,每日剂量每2周减少3毫克,没有临床或生化复发。
结论:该ICPI肝炎病例为,根据我们的知识,文献中第一个用布地奈德单药治疗。因此,布地奈德可能是治疗ICPI相关肝损伤的潜在有吸引力的选择,因为它的安全性和在选定的患者中更快的免疫疗法重新激发的潜在优势,而不需要剂量逐渐减少。与全身作用的皮质类固醇相反。将来应该进行临床试验,以验证或反驳这些发现。