Immune-mediated Gastritis in a Patient with metastatic Lung Cancer due to Therapy with the immune Checkpoint Inhibitor Pembrolizumab – Differences and Similarities in Comparison to “endogenous” autoimmune Type A Gastritis and a review of literature

Abstract

Immune checkpoint inhibitors are increasingly used in advanced malignant diseases and are well-known for their good results. With the blockade of immune checkpoints, the probability of immune-related adverse events is also increased.

We present a 54-year-old female patient with advanced NSCLC. She was treated with pembrolizumab and developed a stable disease under therapy. After six cycles, she presented with massive epigastric pain to our emergency department. Gastroscopy showed severe erosive-fibrinous pangastritis without the involvement of the esophagus, duodenum, or other immune-related adverse effects. Histology showed the complete destruction of the gastric mucosa. We concluded an immune-mediated gastritis by pembrolizumab, after the exclusion of other differential diagnoses.

Despite treatment with prednisolone and marked improvement of her symptoms, the mucosa was never fully reconstituted into a healthy mucosa.

Furthermore, we collected published reports of similar cases and conducted a comparison with features of a typical, endogenous type A gastritis to highlight similarities and differences.

Zusammenfassung

Immun-Checkpoint-Inhibitoren finden immer häufiger Anwendung in der Therapie von fortgeschrittenen Tumorleiden und sind inzwischen bekannt für ihre Effektivität. Bedingt durch ihren Wirkmechanismus kommt es allerdings auch zu immunvermittelten Nebenwirkungen.

Wir präsentieren den Fall einer 54-jährigen Patientin, die bei fortgeschrittenem NSCLC mit Pembrolizumab behandelt wurde. Darunter wurde eine stable disease erreicht. Nach 6 Zyklen Pembrolizumab stellte sie sich mit stärksten epigastrischen Schmerzen in unserer Notaufnahme vor. In der Gastroskopie zeigte sich eine fibrinös-erosive Pangastritis, ohne jegliche Beteiligung von Ösophagus und Duodenum oder eines anderen Organsystems. Die histologische Untersuchung des gastralen Gewebes zeigte eine vollständige Destruktion des Epithels. Nach Ausschluss einer klassischen Typ A-, B- oder C-Gastritis, schlussfolgerten wir eine immunvermittelte Gastritis durch Pembrolizumab.

Auch nach Therapie mit Prednisolon und trotz deutlicher klinischer Befundbesserung rekonstituierte sich die Mukosa auch nach 6 Monaten nicht mehr vollständig.

Des Weiteren führten wir eine Literaturrecherche zu publizierten Fällen ähnlicher Gastritiden unter Pembrolizumab durch und verglichen das Krankheitsbild mit der klassischen Typ A-Gastritis.

Schlüsselwörter

Immunvermittelte Gastritis - Autoimmungastritis - Typ A Gastritis - Nicht-kleinzelliges Bronchialkarzinom - Immuncheckpoint-Inhibitor - Pembrolizumab

Keywords

immune-mediated gastritis - autoimmune gastritis - type A gastritis - non-small cell lung cancer - immune checkpoint inhibitor - pembrolizumab

Publikationsverlauf

Eingereicht: 07. November 2022

Angenommen nach Revision: 13. Dezember 2022

Artikel online veröffentlicht:
24. März 2023

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