PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature

Background. Recurrent endometrial cancer after definitive therapy is a lethal disease. Recently, immune checkpoint inhibitors (ICI) have improved the management of mismatch repair-deficient (MSI-H) endometrial cancer. Autoimmune side effects are known to occur with ICI. As a result, patients with pr...

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Main Authors: Amanda Ramos, Marcela del Carmen, Oladapo Yeku
Format: Article
Language:English
Published: Wiley 2020-01-01
Series:Case Reports in Oncological Medicine
Online Access:http://dx.doi.org/10.1155/2020/3428945
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author Amanda Ramos
Marcela del Carmen
Oladapo Yeku
author_facet Amanda Ramos
Marcela del Carmen
Oladapo Yeku
author_sort Amanda Ramos
collection DOAJ
description Background. Recurrent endometrial cancer after definitive therapy is a lethal disease. Recently, immune checkpoint inhibitors (ICI) have improved the management of mismatch repair-deficient (MSI-H) endometrial cancer. Autoimmune side effects are known to occur with ICI. As a result, patients with preexisting autoimmune diseases are excluded from studies involving these drugs. This has led to challenges in clinical practice regarding the use of ICI in otherwise eligible patients with underlying autoimmune disease. Case Presentation. We present the case of an 81-year-old woman with an underlying autoimmune vasculitis and recurrent, metastatic endometrial adenocarcinoma with microsatellite instability, who was treated with an immune checkpoint inhibitor. This patient received pembrolizumab, an immune checkpoint inhibitor that targets the programmed cell death-1 immune checkpoint. Ultimately, she was treated for 4 months with pembrolizumab and benefited from stable disease during this period. She remained asymptomatic from her underlying autoimmune P-ANCA vasculitis. A review of the scientific literature reveals several cases of the successful use of immune checkpoint inhibitors in patients with autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease. Conclusion. This is one of the first reports of a patient with an underlying autoimmune vasculitis successfully treated with an immune checkpoint inhibitor without exacerbating her underlying autoimmune condition. Carefully selected patients with underlying autoimmune vasculitis can be safely treated with ICI.
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spelling doaj-art-736e94c2916a42d1bb99a6e0f1ca733d2025-02-03T05:53:53ZengWileyCase Reports in Oncological Medicine2090-67062090-67142020-01-01202010.1155/2020/34289453428945PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the LiteratureAmanda Ramos0Marcela del Carmen1Oladapo Yeku2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hartford Healthcare, Hartford, CT 06102, USADivision of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Harvard Medical School, Boston, MA 02114, USAGynecologic Cancers Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USABackground. Recurrent endometrial cancer after definitive therapy is a lethal disease. Recently, immune checkpoint inhibitors (ICI) have improved the management of mismatch repair-deficient (MSI-H) endometrial cancer. Autoimmune side effects are known to occur with ICI. As a result, patients with preexisting autoimmune diseases are excluded from studies involving these drugs. This has led to challenges in clinical practice regarding the use of ICI in otherwise eligible patients with underlying autoimmune disease. Case Presentation. We present the case of an 81-year-old woman with an underlying autoimmune vasculitis and recurrent, metastatic endometrial adenocarcinoma with microsatellite instability, who was treated with an immune checkpoint inhibitor. This patient received pembrolizumab, an immune checkpoint inhibitor that targets the programmed cell death-1 immune checkpoint. Ultimately, she was treated for 4 months with pembrolizumab and benefited from stable disease during this period. She remained asymptomatic from her underlying autoimmune P-ANCA vasculitis. A review of the scientific literature reveals several cases of the successful use of immune checkpoint inhibitors in patients with autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease. Conclusion. This is one of the first reports of a patient with an underlying autoimmune vasculitis successfully treated with an immune checkpoint inhibitor without exacerbating her underlying autoimmune condition. Carefully selected patients with underlying autoimmune vasculitis can be safely treated with ICI.http://dx.doi.org/10.1155/2020/3428945
spellingShingle Amanda Ramos
Marcela del Carmen
Oladapo Yeku
PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
Case Reports in Oncological Medicine
title PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
title_full PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
title_fullStr PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
title_full_unstemmed PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
title_short PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature
title_sort pd 1 inhibitor therapy in a patient with preexisting p anca vasculitis a case report and review of the literature
url http://dx.doi.org/10.1155/2020/3428945
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AT marceladelcarmen pd1inhibitortherapyinapatientwithpreexistingpancavasculitisacasereportandreviewoftheliterature
AT oladapoyeku pd1inhibitortherapyinapatientwithpreexistingpancavasculitisacasereportandreviewoftheliterature