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Anti-PD-1 Therapy-Associated Perforating Colitis
Romulo Celli1, Harriet M Kluger2, Xuchen Zhang1
1Department of Pathology, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
Abstract:
Inhibition of immune checkpoint T cell regulatory molecules by using programmed cell death protein 1 (PD-1), or its ligand (PDL-1), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) has been increasingly used to treat advanced malignancies. The immune-related adverse effects associated with these treatments such as diarrhea, colitis, and CTLA-4 treatment-associated perforating colitis have been reported. However, anti-PD-1/PD-L1-associated perforating colitis has rarely been reported. We report a case of colonic perforation in a patient recently treated with pembrolizumab, a PD-1 inhibitor for metastatic melanoma. Awareness of anti-PD-1/PD-L1-associated colitis and perforation will facilitate a timely diagnosis and management as they are increasingly used in oncology.
Insights
Immune checkpoint inhibitors like PD-1 blockers can cause colitis. This case highlights a rare instance of colonic perforation associated with PD-1 inhibitor treatment for advanced melanoma.
Area of Science:
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1), its ligand (PDL-1), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) are established treatments for advanced cancers.
- While immune-related adverse effects like colitis are known for these therapies, perforating colitis linked to anti-PD-1/PD-L1 agents is uncommon.
Observation:
- A patient with metastatic melanoma developed colonic perforation.
- This event occurred following recent treatment with pembrolizumab, a PD-1 inhibitor.
Findings:
- This case represents a rare occurrence of perforating colitis associated with anti-PD-1/PD-L1 therapy.
- The patient's condition was linked to pembrolizumab treatment for metastatic melanoma.
Implications:
- Increased awareness of anti-PD-1/PD-L1-associated colitis and perforation is crucial.
- Timely diagnosis and management are essential for patients receiving these increasingly utilized immunotherapies.
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