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Vandepapelière J, Siplet J, Libbrecht L, Dano H, Baurain JF, Moreels T. Auto-immune gastritis induced by pembrolizumab, an anti-PD-1, in a melanoma patient. Acta Gastroenterol Belg 2020; 83:482-484. [PMID: 33094598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a case of a 67-years-old woman presenting a severe acute lymphocytic gastritis induced by pembrolizumab, an immune check point inhibitor (ICI). This gastritis was her third auto-immune adverse event after 5 years of treatment with pembrolizumab, it was metabolically active at the PET Scan and confirmed by analysis of the gastric biopsies. Pembrolizumab treatment cessation and high doses of corticosteroids completely normalized the stomach clinically, endoscopically and histologically. This patient was in complete remission of her metastatic melanoma. Therefore, pembrolizumab therapy was not restarted and the patient is still in remission 6 months later. This strategy is supported by recent publications describing a relapse rate inferior to 10% in patients in complete remission after 2 years of immunotherapy. Particularities of this case are: rareness of this adverse event, late onset after introduction of pembrolizumab, evocative PET scan image, specific endoscopic aspect and histology. In addition, the favorable oncologic evolution of the patient after treatment cessation confirms the prolonged remission after immunotherapy.
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Affiliation(s)
- J Vandepapelière
- Division of Oncology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - J Siplet
- Division of Gastroenterology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - L Libbrecht
- Division of Anatomopathology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - H Dano
- Division of Anatomopathology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - J F Baurain
- Division of Oncology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - T Moreels
- Division of Gastroenterology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
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Vandepapelière J, Aydin S, Cosyns JP, Depresseux G, Jadoul M, Houssiau FA. Prognosis of proliferative lupus nephritis subsets in the Louvain Lupus Nephritis inception Cohort. Lupus 2013; 23:159-65. [DOI: 10.1177/0961203313514623] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this paper is to evaluate whether the different International Society of Nephrology/Renal Pathology Society (ISN/RPS) classes of proliferative lupus nephritis (LN) have a distinct baseline presentation, short-term response to immunosuppression (IS) and long-term prognosis. Methods Ninety-eight patients with new onset (first renal biopsy) ISN/RPS proliferative LN (Class III: n = 24; IV-S: n = 23; IV-G: n = 51) were diagnosed at our institution between 1995 and 2012 (Louvain Lupus Nephritis inception Cohort). Their baseline renal parameters, primary response to IS at one year, survival and long-term renal outcome (mean follow-up: 77 months) were compared. Results At baseline, serum creatinine and 24-hour proteinuria were higher in Class IV-G, as was activity index on renal biopsy in Class IV-S and IV-G compared to III. Upon treatment, renal parameters improved with the same kinetics and to the same extent in the three pathological classes. On repeat renal biopsies ( n = 43), activity indices dropped similarly. Poor outcomes (death, end-stage renal disease, renal impairment defined by an eGFR <60 ml/min/1.73 m2) did not statistically differ between groups, although there was a trend toward more renal impairment at follow-up in Class IV-G compared to IV-S and III. Finally, the presence of even mild chronic lesions on baseline biopsy was clearly predictive of late renal outcome. Conclusion Subsetting proliferative LN into Class III, IV-S and IV-G provides less clinically discriminant prognostic information than baseline chronicity index.
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Affiliation(s)
- J Vandepapelière
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - S Aydin
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - J-P Cosyns
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - G Depresseux
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - M Jadoul
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - FA Houssiau
- Department of Rheumatology; 2Department of Pathology; 3Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales; and 5Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Vandepapelière J, Aydin S, Depresseux G, Cosyns JP, Jadoul M, Houssiau FA. THU0323 Subsettting Proliferative Lupus Nephritis According to the ISN/RPS Classification Does not Provide Valuable Prognostic Information. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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