Balancing the Checkpoint: Managing Colitis Associated with Dual Checkpoint Inhibitors and High-Dose Aspirin.
Balancing the Checkpoint: Managing Colitis Associated with Dual Checkpoint Inhibitors and High-Dose Aspirin.
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平衡检查点：治疗与双检查点抑制剂和大剂量阿司匹林相关的结肠炎。
DOI：
10.1007/s10620-019-05534-5
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发表时间：
2019
影响因子：
3.1
通讯作者：
Kattah,MichaelG
中科院分区：
文献类型：
--
作者：
Hammami,MuhammadB;Gill,Ryan;Thiruvengadam,Nikhil;Oh,DavidY;Beck,Kendall;Mahadevan,Uma;Kattah,MichaelG
作为临床试验 (NCT03396952) 的一部分，两名转移性黑色素瘤患者在接受第二个疗程的双免疫检查点抑制剂 (ICPI) 治疗（派姆单抗和伊匹单抗，每 3 周一次）联合环氧合酶 (COX) 抑制（阿司匹林 975 毫克，每天两次）后，因严重腹泻住院。两名患者均无炎症性肠病 (IBD) 病史。患者 1 是一名 71 岁男性，患有复发性 3 期转移性黑色素瘤。他完成了两个周期的 ICPI 和阿司匹林联合治疗，没有出现不良事件。第 1 周期后五周，他出现恶心和每天 3-4 次稀便，尽管使用止吐药（昂丹司琼）和抗蠕动剂（洛哌丁胺）治疗，但这种情况持续存在。接下来的一周，他被发现患有中度转氨炎（ALT 峰值 172 U/L）。每天使用泼尼松 100 毫克进行经验性治疗与转氨酶正常化相关。然而，腹泻恶化至每 24 小时 > 10 次的频率。第一周期后七周，他住院接受进一步治疗。患者 2 是一名 81 岁男性，患有复发性 4 期转移性黑色素瘤。就在第二个周期的易普利姆玛治疗之前，他每天出现两次稀便，
Two patients with metastatic melanoma were hospitalized for severe diarrhea after receiving their second course of dual immune checkpoint inhibitor (ICPI) therapy (pembrolizumab and ipilimumab every 3 weeks) in combination with cyclooxygenase (COX) inhibition (aspirin 975 mg twice daily), as part of a clinical trial (NCT03396952). Neither patient had a prior history of inflammatory bowel disease (IBD).Patient 1 is a 71-year-old male with recurrent stage 3 metastatic melanoma. He completed two cycles of combination of ICPI and aspirin therapy without adverse events. Five weeks following cycle 1, he developed nausea and 3–4 loose bowel movements per day that persisted despite treatment with antiemetics (ondansetron) and antimotility agents (loperamide). The following week, he was noted to have a moderate transaminitis (peak ALT 172 U/L). Empiric treatment with prednisone 100 mg daily was associated with normalization of his transaminases. The diarrhea, however, worsened to a frequency of> 10 per 24 h. Seven weeks following cycle 1, he was hospitalized for further management. Patient 2 is an 81-year-old male with recurrent stage 4 metastatic melanoma. Just prior to his second cycle of ipilimumab, he developed two loose bowel movements per day,