Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab
Manuel A. Baarslag, Joosje H. Heimovaara, Jessica S.W. Borgers, Koen van Aerde, Hans J. P. M. Koenen, Ruben L. Smeets, Pauline L.M. Buitelaar, Dick Pluim, Shoko Vos, Stefanie Henriet, Jan Willem B. de Groot, Martine van Grotel, Hilde Rosing, Jos H. Beijnen, Alwin D. R. Huitema, John B.A.G. Haanen, Frédéric Amant, N. Gierenz
Abstract
Immune checkpoint blockade has become standard treatment for many types of cancer. Such therapy is indicated most often in patients with advanced or metastatic disease but has been increasingly used as adjuvant therapy in those with early-stage disease. Adverse events include immune-related organ inflammation resembling autoimmune diseases. We describe a case of severe immune-related gastroenterocolitis in a 4-month-old infant who presented with intractable diarrhea and failure to thrive after in utero exposure to pembrolizumab. Known causes of the symptoms were ruled out, and the diagnosis of pembrolizumab-induced immune-related gastroenterocolitis was supported by the results of histopathological assays, immunophenotyping, and analysis of the level of antibodies against programmed cell death protein 1 (PD-1). The infant's condition was successfully treated with prednisolone and infliximab.