Abstract
The HIMALAYA trial is the first chemotherapeutic trial to demonstrate the efficacy of combined immune checkpoint inhibitors (ICIs) for unresectable hepatocellular carcinoma (u-HCC). The STRIDE regimen used in this trial consists of a cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor and programmed cell death ligand 1 (PD-L1) inhibitor. Herein, we report two cases of ICI-colitis that occurred immediately after the initiation of the STRIDE regimen for u-HCC. A 73-year-old man and 75-year-old man with u-HCC were treated with the STRIDE regimen. Both patients developed grade 3 diarrhea (Common Terminology Criteria for Adverse Events, ver. 5.0) within 10 days of treatment initiation. Colonoscopy revealed aphthous erosions and erythema extending from the terminal ileum to the rectum in one case, while the other showed aphthous ulcers in the terminal ileum and shallow ulcers in the colorectum. Histopathological examination of a biopsy specimen revealed epithelial cell apoptosis and neutrophil infiltration bodies, consistent with ICI-colitis. Prednisolone (0.5 mg/kg) was effective in both patients. Our experience suggests the need for both careful monitoring and early endoscopic examination of ICI colitis in patients with unresectable HCC treated with the STRIDE regimen.
Similar content being viewed by others
Abbreviations
- ICIs:
-
Immune checkpoint inhibitors
- u-HCC:
-
Unresectable hepatocellular carcinoma
- CTLA-4:
-
Cytotoxic T-lymphocyte antigen-4
- PD-L1:
-
Programmed cell death ligand 1
- irAE:
-
Immune-related adverse events
- RFA:
-
Radiofrequency ablation
- TACE:
-
Transcatheter arterial chemoembolization
- CT:
-
Computed tomography
References
Abou-Alfa GK, Lau G, Kudo M, et al. Tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. NEJM Evid. 2022;1:2100070.
Wang DY, Salem JE, Cohen JV, et al. Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol. 2018;4:1721–8.
Martins F, Sofiya L, Sykiotis GP, et al. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol. 2019;16:563–80.
Yanai S, Toya Y, Sugai T, et al. Gastrointestinal adverse events induced by immune-checkpoint inhibitors. Digestion. 2021;102:965–73.
Fukushima T, Morimoto M, Kobayashi S, et al. Association between immune-related adverse events and survival in patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab. Oncologist. 2023;28:e526–33.
Acknowledgements
We would like to thank Koko Motodate for providing excellent secretarial support and Japan Medical Communication for editing the English language of this paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest or financial support associated with this study.
Ethical approval
This study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments.
Informed consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Abe, H., Endo, K., Kuroda, H. et al. Immune checkpoint inhibitor-associated colitis in unresectable hepatocellular carcinoma: two cases of early onset after treatment with durvalumab plus tremelimumab. Clin J Gastroenterol 17, 307–310 (2024). https://doi.org/10.1007/s12328-023-01901-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-023-01901-y