Pembrolizumab
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Grade 2 arthralgia and development of acquired drug resistance: case report A 39-year-old woman developed grade 2 arthralgia and acquired drug resistance during treatment with pembrolizumab for refractory metastatic microsatellite instability-high (MSI-H) colorectal cancer (CRC). The woman, who had MSI-H CRC liver-limited metastatic disease, received six cycles of curative-intent FOLFOX therapy consisting of fluorouracil and oxaliplatin prior to undergoing resection of her liver metastases on 4 August 2016. On 8 December 2016, she completed her further six cycles of FOLFOX therapy. On 18 December 2016, a progressive disease in her lungs and liver was observed. Thereafter, the next-generation sequencing of the liver metastectomy sample was performed, which revealed a BRCA1 mutation. Therefore, she was initiated on FOLFIRI therapy comprising of fluorouracil and irinotecan with an unspecified matrix metalloproteinase-9 inhibitor as a part of clinical trial. This therapy was continued until 10 January 2018. Due to difficulty tolerating the previous therapy and mild progression of the pulmonary lesions, she started receiving pembrolizumab 200mg monotherapy every 3 weeks [route not stated]. She tolerated pembrolizumab monotherapy well, except grade II arthralgia. The woman was treated with two short courses of prednisone in June 2018 and October 2018. From 10 October 2018, a stable disease was achieved. However, a mild growth of her pulmonary nodules was observed. From 29 December 2018, an overt disease progression in her liver was noted. The stable disease on pembrolizumab for 8 months prior to the progression was suggestive of development of acquired resistance to pembrolizumab [duration of treatment to reactions onset and outcome not stated]. Considering the other options for sustained disease control, initial disease stability on pembrolizumab and robust performance status, she was initiated on combination immunotherapy with nivolumab and ipilimumab. After completion of four doses of combination therapy (on 23 March 2019), CT scan showed stable disease with shrinkage of her dominant liver and left ovarian metastases. Thereafter, she received nivolumab maintenance monotherapy. Her scan on 1 June 2019 revealed a partial response. Das S, et al. Immunotherapy After Immunotherapy: Response Rescue in a Patient With Microsatellite Instability-high Colorectal Cancer Post-Pembrolizumab. Clinical 803497430 Colorectal Cancer 19: 137-140, No. 2, Jun 2020. Available from: URL: http://doi.org/10.1016/j.clcc.2020.02.006
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Reactions 22 Aug 2020 No. 1818
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