演題抄録

ポスター

開催概要
開催回
第56回・2018年・横浜
 

イピリマブの関与が考えられ緊急手術を要した大腸炎の2例

演題番号 : P17-1

[筆頭演者]
演者)成瀬 貴之:1 
[共同演者]
小練 研司:1、西野 拓磨:1、呉林 秀崇:1、横井 繁周:1、森川 充洋:1、玉木 雅人:1、村上 真:1、廣野 靖夫:1、前田 浩幸:1、片山 寛次:2、五井 孝憲:1

1:福井大学・第一外科、2:福井大学附属病院・がん診療推進センター

 

Background:Recently, an immune checkpoint inhibitor has appeared as a new antineoplastic agent, and it is expected that adaptation will expand to various cancer types in the future, including malignant melanoma currently approved. On the other hand, its mechanism of action causes various immune related adverse events (irAE) different from conventional antineoplastic agents. We report two cases in which colitis occurred by administration of Ipilimumab and an emergency operation was required. Case1:A-79-years-old female presented our hospital due to abdominal pains. She received 6 courses of Nivolumab for the treatment of nasal mucosal malignant melanoma, but since it was PD then she received 4 courses of Ipilimumab. CT examination showed thickening of the wall from the ileoceal area, suggesting the possibility of both appendicitis and drug enteritis. Although the preservative treatment was performed, it did not improve, and the ileocecal resection was performed on the 10th disease day. Case2:A-79-years-old male presented our hospital due to abdominal pains and nausea. He received 15 courses of Nivolumab for the treatment of the left sole malignant melanoma, but since it was PD then he received 2 courses of Ipilimumab. CT examination, inflammation of the ascending colon was observed from the terminal ileum accompanied by enterohemorrhagia, portal venous gas, and right colon resection was performed. Discussion: Diabetes is the most common in intestinal-related irAE due to Ipilimumab administration, it is said that Grade 3-4 occurs in about 10%.And, It is reported that gastrointestinal perforation due to serious colitis occurs in about 1%. The basic principle of coping with irAE is considered to be an appropriate immunosuppressive therapy according to the diagnosis and severity as early as possible, but as in this two cases, occasionally a serious disease condition requiring emergency operation. There is a high possibility that similar cases will increase in the future.

キーワード

臓器別:大腸・小腸

手法別:化学療法

前へ戻る