Pembrolizumab
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Colitis, interstitial lung disease and acute exacerbation of preexisting interstitial lung disease: 5 case reports In a retrospective study of 25 patients receiving pembrolizumab between March 2017 and December 2018, 5 patients including 4 men aged between 75–81 years [not all ages and sexes stated] were described, who developed acute exacerbation of preexisting interstitial lung disease (ILD), ILD or colitis during treatment with pembrolizumab for advanced non-small-cell lung cancer (NSCLC) [routes not stated; not all times to reaction onsets and outcomes stated]. Case 2: The 76-year-old man with NSCLC (cT4N0 m0) was diagnosed with pleomorphic carcinoma (pT4N0 m1a) with pleural dissemination following left lower lobectomy. Additionally, he had preexisting ILD (pattern: nonspecific interstitial pneumonia). He started receiving pembrolizumab monotherapy 200 mg on day 1 every 3 weeks. However, on day 294 of pembrolizumab therapy, he developed cough and anorexia with oxygen desaturation. A chest CT showed ground glass opacity (GGO) in the bilateral lung fields, indicating grade III drug-related acute exacerbation of preexisting ILD. He was then treated with prednisolone. A subsequent chest X-ray revealed reduction in the opacity with improved oxygenation. Case 3: The 78-year-old man with stage IV NSCLC and pleural dissemination started receiving pembrolizumab monotherapy 200 mg on day 1 every 3 weeks. He also had preexisting ILD (pattern: nonspecific interstitial pneumonia). However, on day 48 of pembrolizumab therapy, he developed dyspnoea with oxygen desaturation. A chest CT revealed GGO predominantly on the right side in both lungs. He was hospitalised and treated with methylprednisolone, followed by oral prednisolone for grade III drugrelated acute exacerbation of preexisting ILD. But, the chest X-ray revealed an expansion of the reticular opacity in the both lungs, and he was treated with cyclophosphamide pulse therapy on day 53, and a second round of prednisolone therapy. Thereafter, X-ray revealed a reduction in the interstitial shadow, and he was discharged with home oxygen therapy and unspecified corticosteroid therapy on day 78. Case 4: The 81-year-old man with stage IV NSCLC (adenosquamous carcinoma) and pleural dissemination, started receiving pembrolizumab monotherapy 200 mg on day 1 every 3 weeks. He also had preexisting ILD (pattern: usual interstitial pneumonia). On day 60 of pembrolizumab therapy, chest CT revealed patchy GGO in the bilateral lung fields, with shortness of breath on exertion. He had oxygen desaturation; pembrolizumab was withdrawn with a diagnosis of grade III drug-related acute exacerbation of preexisting ILD. He was hospitalised and treated with methylprednisolone, followed by cyclophosphamide pulse and oral prednisolone. His X-ray on day 70 showed that the opacity had gradually reduced, and he was discharged with home oxygen therapy on day 74. Case 5: The 75-year-old man with stage IV NSCLC (adenosquamous carcinoma) and multiple bone metastases, started receiving pembrolizumab
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