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Fan Y, Zhao J, Mi Y, Zhang Z, Geng Y, Zhou L, Shen L, Zhang Z. Recurrent Cystitis Associated With 2 Programmed Death 1 Inhibitors: A Rare Case Report and Literature Review. J Immunother 2023; 46:341-345. [PMID: 37721343 PMCID: PMC10540753 DOI: 10.1097/cji.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced cancer, however, often with immune-related adverse events (irAEs). Adverse events involving the bladder were extremely rare with only few cases. Herein, we described a rare, recurrent cystitis associated with 2 programmed death 1 inhibitors (pembrolizumab and toripalimab) in 1 patient with advanced liver cancer. Cystitis associated with toripalimab, a novel humanized programmed death 1 monoclonal antibody, was first presented in our case. Cystitis is an extremely rare irAE associated with ICIs, especially anti-programmed death 1 antibodies. With widening indications of ICIs in clinical practice, physicians should be also aware of this rare irAE.
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Affiliation(s)
- Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yue Mi
- Department of Urology, National Urological Cancer Center, Peking University First Hospital, Beijing, China
| | - Zhening Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Liqun Zhou
- Department of Urology, National Urological Cancer Center, Peking University First Hospital, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
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LI S, ZHENG K, XU Y, WANG M. [Immune Checkpoint Inhibitors Related Cystoureteritis:
A Case Report and Literature Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:709-716. [PMID: 37985157 PMCID: PMC10600747 DOI: 10.3779/j.issn.1009-3419.2023.106.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/22/2023]
Abstract
A patient with advanced lung adenocarcinoma developed symptoms of frequent urination and urgent urination after 14 cycles of Pembrolizumab combined with chemotherapy. After making comprehensive analysis of the results of urine routine test, renal function, cystoscope and computed tomography (CT) examination, immune checkpoint inhibitors related cystoureteritis and acute kidney injury were considered. The patient's symptoms were relieved after discontinuation of Pembrolizumab combined with chemotherapy. However, the symptoms of urinary irritation worsened significantly after rechallenging Pembrolizumab combined with chemotherapy, and the symptoms was relieved after corticosteroids treatment. If patients develop urinary symptoms during immune checkpoint inhibitors treatment, immune checkpoint inhibitors related cystoureteritis should be considered for early differential diagnosis in order to implement appropriate treatment.
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Anraku T, Hashidate H, Imai T, Kawakami Y. Successful treatment of immune‐related cystitis with bladder hydrodistension. IJU Case Rep 2023. [DOI: 10.1002/iju5.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Tsutomu Anraku
- Department of Urology Niigata City General Hospital Niigata Japan
| | - Hideki Hashidate
- Department of Pathology Niigata City General Hospital Niigata Japan
| | - Tomoyuki Imai
- Department of Urology Niigata City General Hospital Niigata Japan
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Li J, Yu YF, Qi XW, Du Y, Li CQ. Immune-related ureteritis and cystitis induced by immune checkpoint inhibitors: Case report and literature review. Front Immunol 2023; 13:1051577. [PMID: 36685488 PMCID: PMC9853439 DOI: 10.3389/fimmu.2022.1051577] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte-associated protein 4 (anti-CTLA4) and anti-programmed death cell protein 1 (anti-PD-1), are increasingly prescribed in metastatic carcinoma therapy. ICI-related kidney injury is gradually recognized by clinicians. However, immune-related ureteritis and cystitis easily go undiagnosed. We report three cases of PD-1 monoclonal antibody (mAb)-related ureteritis and cystitis. We further carried out a review of the literature about ICI-related ureteritis and cystitis. The cases in our reports manifest urinary irritation, sterile pyuria, gross hematuria, hydronephrosis, dilation of the ureters, and acute kidney injury. Urinary irritation improved effectively; urinalysis and renal function returned to normal after glucocorticoid therapy. During ICI therapy, urinalysis and renal function and urinary imaging examination are recommended to be monitored regularly. It contributes to identify immune-related ureteritis/cystitis earlier to efficiently alleviate urinary symptoms and immunologic urinary tract injury through glucocorticoid therapy while avoiding the abuse of antibiotics.
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Affiliation(s)
- Jun Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China,Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China,*Correspondence: Jun Li,
| | - Ya-Fen Yu
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xiao-Wei Qi
- Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Du
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Chun-Qing Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Fukunaga H, Sumii K, Kawamura S, Okuno M, Taguchi I, Kawabata G. A case of steroid‐resistant cystitis as an immune‐related adverse event during treatment with nivolumab for lung cancer, which was successfully treated with infliximab. IJU Case Rep 2022; 5:521-523. [PMID: 36341187 PMCID: PMC9626353 DOI: 10.1002/iju5.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Immune checkpoint inhibitors are widely used in various cancers as a standard treatment. However, while various immune‐related adverse events related to immune checkpoint inhibitors have been reported, there are few reports of lower urinary tract symptoms. Case presentation The patient was a 60‐year‐old man with primary lung cancer who was receiving long‐term nivolumab therapy. He was referred to our department due to the sudden onset of glans penile pain and micturition pain. We suspected non‐bacterial cystitis as an immune‐related adverse event caused by nivolumab and were able to treat it by administering prednisolone. While his symptoms and findings on cystoscopy recurred during prednisolone therapy, we were able to treat him again by administering an additional dose of infliximab. Conclusion A few reports have described cases of immune checkpoint inhibitor‐induced cystitis for which prednisolone was effective. This report is the first to describe cystitis as a steroid‐resistant immune‐related adverse event.
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Affiliation(s)
| | - Kenta Sumii
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Shun Kawamura
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Masato Okuno
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Isao Taguchi
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Gaku Kawabata
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
- Department of Urology Hakuhokai Central Hospital Amagasaki‐shi Japan
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Badheeb A, Alkhanbashi O, Rakrouki S, Mahmood T, Alqannas M, Badheeb M, Ahmed F. Bladder rupture after pembrolizumab immunotherapy for bladder cancer: a case report. Pan Afr Med J 2022; 42:98. [PMID: 36034031 PMCID: PMC9379440 DOI: 10.11604/pamj.2022.42.98.33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/01/2022] [Indexed: 12/28/2022] Open
Abstract
Pembrolizumab is a promising checkpoint inhibitor for advanced urothelial carcinoma. Like other immunotherapies, it can cause rare immune-related adverse events. The spontaneous rupture of the urinary bladder after the intravenous injection of pembrolizumab is rare and has not been reported. Here, we present a 74-year-old man patient case of locally advanced transitional cell carcinoma of the urinary bladder who presented severe abdominal pain the same day of the second dose of pembrolizumab administration. The exploratory laparotomy revealed intraperitoneal rupture of the urinary bladder associated with peritonitis. After surgical repair, the patient's condition improved. The purpose of this report is to discuss the possible association of bladder perforation in bladder cancer with pembrolizumab immunotherapy, its management, and the importance of early recognition to prevent more fatal complications.
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Affiliation(s)
- Ahmed Badheeb
- Oncology Center, King Khalid Hospital, Najran, Saudi Arabia
| | - Omar Alkhanbashi
- Department of Urology, King Khalid Hospital, Najran, Saudi Arabia
| | - Slah Rakrouki
- Department of Urology, King Khalid Hospital, Najran, Saudi Arabia
| | - Tahir Mahmood
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mashhoor Alqannas
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohamed Badheeb
- Department of Internal Medicine, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
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Immune-Related Uncommon Adverse Events in Patients with Cancer Treated with Immunotherapy. Diagnostics (Basel) 2022; 12:diagnostics12092091. [PMID: 36140493 PMCID: PMC9498261 DOI: 10.3390/diagnostics12092091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/06/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Immunotherapy has dramatically changed the therapeutic landscape of oncology, and has become standard of care in multiple cancer types in front or late lines of therapy, with some longstanding responses and outstanding results. Notwithstanding, its use has brought a totally unique spectrum of adverse events, characterized by a myriad of diverse manifestations affecting nearly every organ and system of the body, including the endocrine, nervous, cardiac, respiratory and gastrointestinal systems. Uncommon adverse events, defined as those occurring in less than 1% of patients, comprise an even more heterogeneous group of diseases that are being seen more recurrently as the use of immune check-point inhibitors increases and indications spread in different tumor types and stages. Here, we comprehensively review some uncommon, but exceedingly important, immune-related adverse events, with special emphasis in the clinical approach and diagnostic workup, aiming to reunite the evidence published previously, allowing an increase in awareness and knowledge from all specialists implicated in the diagnosis, treatment, and care of cancer patients treated with immunotherapy.
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Obayashi A, Hamada-Nishimoto M, Fujimoto Y, Yoshimoto Y, Takahara S. Non-bacterial Cystitis With Increased Expression of Programmed Cell Death Ligand 1 in the Urothelium: An Unusual Immune-Related Adverse Event After Atezolizumab Administration for Metastatic Breast Cancer. Cureus 2022; 14:e25486. [PMID: 35800819 PMCID: PMC9246443 DOI: 10.7759/cureus.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/05/2022] Open
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Non-bacterial cystitis secondary to pembrolizumab: A case report and review of the literature. Curr Probl Cancer 2022; 46:100863. [DOI: 10.1016/j.currproblcancer.2022.100863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/10/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022]
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Tu L, Ye Y, Tang X, Liang Z, You Q, Zhou J, Pan Z. Case Report: A Case of Sintilimab-Induced Cystitis/Ureteritis and Review of Sintilimab-Related Adverse Events. Front Oncol 2022; 11:757069. [PMID: 35004277 PMCID: PMC8733470 DOI: 10.3389/fonc.2021.757069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 01/26/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have been proven to be beneficial in multiple advanced malignancies. However, the widespread use of ICIs also occurred with various immune-related adverse events (irAEs). Here, we first report a case of sintilimab-related cystitis/ureteritis. A 53-year-old man with driver gene-negative pulmonary adenocarcinoma (cT1cN3M1c, Stage IVB) was being treated with sintilimab in combination of paclitaxel-albumin and bevacizumab as second-line treatment. He was hospitalized for haematuria, pollakiuria, painful micturition and low back pain after three courses. Urinalysis showed red blood cells (RBCs) and white blood cells (WBCs) were obviously increased, and serum creatinine (sCr) level was also significantly elevated. Urine culture and cytology were both negative, and cystoscopy revealed diffused redness of bladder mucosa. Urinary ultrasonography showed mild hydronephrosis and dilated ureter. The patient was diagnosed as immunotherapy-related cystitis/ureteritis after a multidisciplinary team (MDT) meeting. Once the diagnosis was made, corticosteroid therapy was given, which rapidly resolved the patient's symptoms and signs. Computer tomography angiography (CTA) and CT urography (CTU) was conducted after sCr level was back to normal and demonstrated ureter dilation and hydroureter. Once symptoms relieved, bladder biopsy was performed and confirmed the bladder inflammation. The patient was subsequently switched to maintenance dose of methylprednisolone and tapered gradually. Since sintilimab has been used in advanced malignancies, we first reported a rare case of sintilimab-induced cystitis/ureteritis and summarized sintilimab-related adverse events to improve the assessment and management of irAEs.
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Affiliation(s)
- Lingfang Tu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuan Ye
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoping Tang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Liang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qihan You
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhijie Pan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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