Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature

Nivolumab is a promising monoclonal antibody inhibitor of programmed death-1, a protein on the surface of T-cells. As such, it is approved for use in patients with multiple advanced malignancies and can significantly elongate progression-free survival. However, monoclonal antibody inhibitors can lea...

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Veröffentlicht in:Journal of clinical medicine 2023-07, Vol.12 (14), p.4641
Hauptverfasser: Dibos, Miriam, Dumoulin, Johanna, Mogler, Carolin, Wunderlich, Silke, Reichert, Maximilian, Rasch, Sebastian, Schmid, Roland M, Ringelhan, Marc, Ehmer, Ursula, Lahmer, Tobias
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container_end_page
container_issue 14
container_start_page 4641
container_title Journal of clinical medicine
container_volume 12
creator Dibos, Miriam
Dumoulin, Johanna
Mogler, Carolin
Wunderlich, Silke
Reichert, Maximilian
Rasch, Sebastian
Schmid, Roland M
Ringelhan, Marc
Ehmer, Ursula
Lahmer, Tobias
description Nivolumab is a promising monoclonal antibody inhibitor of programmed death-1, a protein on the surface of T-cells. As such, it is approved for use in patients with multiple advanced malignancies and can significantly elongate progression-free survival. However, monoclonal antibody inhibitors can lead to adverse hepatic reactions, which in rare cases result in further hepatic damage. Herein, we present a case of a patient with locally advanced gastric carcinoma treated with fluorouracil, oxaliplatin, docetaxel and the checkpoint inhibitor nivolumab. Five months after her first dosage of nivolumab and without a preexisting liver disease, she presented with transaminitis. During the course of her stay, the patient developed status epilepticus, which required mechanical ventilation followed by fulminant hepatic failure. A subsequent liver biopsy revealed severe liver damage with extensive confluent parenchymal necrosis corresponding to checkpoint-inhibitor-induced hepatitis. Alternative reasons for this hepatic failure were ruled out. Despite aggressive therapeutic interventions including corticosteroids and plasma exchange, the patient died due to liver failure. Although hepatic failure is rarely seen in patients with checkpoint inhibitor therapy, it requires early awareness and rapid intervention.
doi_str_mv 10.3390/jcm12144641
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source Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central
subjects Acidosis
Ammonia
Cancer therapies
Case Report
Case reports
Case studies
Causes of
Clinical medicine
Consciousness
Diagnostic tests
Drug dosages
Drug therapy
Electroencephalography
Gastric cancer
Hepatitis
Intubation
Ischemia
Laxatives
Liver
Liver failure
Magnetic resonance imaging
Monoclonal antibodies
Outpatient care facilities
Patients
Phosphatase
Stomach cancer
Tomography
Transplants & implants
title Fulminant Liver Failure after Treatment with a Checkpoint Inhibitor for Gastric Cancer: A Case Report and Review of the Literature
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