Chronic intestinal pseudo-obstruction in a patient with metastatic gastro-oesophageal junction cancer receiving treatment with pembrolizumab

Acute gastrointestinal (GI) immune-related adverse events (irAE) are commonly reported by patients with cancer undergoing treatment with immune checkpoint inhibitors (CPI); however chronic irAEs are rare. We present a case of a 71-year-old woman with metastatic gastro-oesophageal junction (GOJ) aden...

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Bibliographic Details
Published in:BMJ case reports 2019-12, Vol.12 (12), p.e232388
Main Authors: Besaw, Robert J, Smith, Martin P, Zerillo, Jessica A, Bullock, Andrea J
Format: Article
Language:English
Subjects:
Abdomen
Adenocarcinoma - diagnostic imaging
Adenocarcinoma - drug therapy
Aged
Antibodies, Monoclonal, Humanized - administration & dosage
Antibodies, Monoclonal, Humanized - adverse effects
Antineoplastic Agents, Immunological - administration & dosage
Antineoplastic Agents, Immunological - adverse effects
Apoptosis
Cancer therapies
Case reports
Colon
Endoscopy
Esophageal Neoplasms - diagnostic imaging
Esophageal Neoplasms - drug therapy
Esophagogastric Junction
Family medical history
Female
Gastric cancer
Health surveillance
Humans
Immunotherapy
Inflammatory bowel disease
Intestinal Pseudo-Obstruction - chemically induced
Intestinal Pseudo-Obstruction - diagnostic imaging
Lymphatic Metastasis - diagnostic imaging
Lymphatic Metastasis - drug therapy
Lymphatic system
Metastasis
Monoclonal antibodies
Motility
Nutrition
Targeted cancer therapy
Ultrasonic imaging
Ultrasonography
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
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Summary:Acute gastrointestinal (GI) immune-related adverse events (irAE) are commonly reported by patients with cancer undergoing treatment with immune checkpoint inhibitors (CPI); however chronic irAEs are rare. We present a case of a 71-year-old woman with metastatic gastro-oesophageal junction (GOJ) adenocarcinoma who developed delayed-onset chronic intestinal pseudo-obstruction (CIPO) while receiving second-line pembrolizumab. Repeated CT scans of the abdomen/pelvis found no small bowel obstruction, and evaluations for bowel inflammation, infection and paraneoplastic syndrome were negative. Bowel rest and glucocorticoids were associated with transient symptom resolution; however, symptoms recurred within 1 month. The patient was ultimately supported with total parenteral nutrition and intestinal motility agents. After 4 months, the GOJ cancer remained stable with no signs of progression. As CPI use expands, the incidence of rare irAEs, such as CIPO, may increase.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-232388