It is important that doctors take into account that once these patients start this type of drug
Dr. Bárbara Rosado Carillo, gastroenterologist and hepatologist from Puerto Rico, part of the authors of the case. Photo: Journal of Medicine and Public Health.
Despite the high effectiveness that monoclonal drugs have reported in the literature, it is known that a small percentage of patients might present adverse effects to this type of treatment, as in all target classes in general.
That was precisely what happened in a patient puerto rican 85 years of age with history medical history of stage 3 laryngeal cancer.
This was treated with chemotherapy due to residual disease and then started her therapy with pembrolizumab, a class of drugs called monoclonal antibodies. It works by helping your immune system slow or stop the growth of cancer cells, she reported to the Journal of Medicine and Public Health the Dr. Bianca Goyco Cortesauthor of the case and part of the residence of Gastroenterology of the Medical Sciences Campus along with Dr. Barbara Rosado Carillo, gastroenterologist and hepatologist Puerto Rico.
“After 6 months of starting therapy, the patient he was referred to our hepatology clinic because he found elevated liver enzymes, associated with this he also had jaundice and decreased appetite, he also had fatigue and pain upper quadrant abdominal right,” described the Dr. Lopez.
“When the patient reaches us, the enzymes are 5 to 10 times above the normal limit, when we see the patient, it was thought that the patient had infiltrative disease, obviously secondary to past medical history, versus liver damage secondary to the drug, so an imaging study was performed that ruled out that the patient have an infiltrative disease and viral disease was ruled out”, he added.
The team made the decision to stop using the medicine pembrolizumab and started the patient on intravenous steroids for three days, followed by oral steroids along with ursodeoxycholic acid, a drug that can limit liver damage and the effect of Hepatitis C.
“Due to such a severe clinical picture, the patient is closely followed up at the clinic and following two weeks the patient he felt much better. Liver enzymes were declining and today, two months later, the patient he is completely asymptomatic, the enzymes are completely normal and he continues to be monitored quite closely, along with his oncologist, “he explained.
Pembrolizumab is a type of immunotherapy that inhibits PDL1, a protein that helps keep immune cells from attacking healthy cells.
Precisely many cancer cells have PDL1 and this might “trick” the immune system to avoid being attacked as foreign and harmful substances. According to the literature, immunotherapy stimulates the immune system to recognize and fight cancer cells.
“Usually when patients have adverse effects, they respond very well to steroids. Likewise, when hepatitis secondary to pembrolizumab occurs, the treatment consists only of discontinuing and monitoring liver enzymes, however, in the case of our patient, he wanted a grade 3 state of damage, since what was obviously decided to do was a little more aggressive. , remove the medicine obviously and start the patient on intravenous steroids and we got a good response”, he celebrated.
He added that drug-induced liver damage is one of the most common causes of elevated liver enzymes, occurring in 1 in 5,000 to 100,000 patients taking over-the-counter medications or nutritional supplements.
“We wanted to bring this case because it is important that doctors take into account that once these patients start this type of drug, it is important that liver enzymes be closely monitored before, during and following treatment, because the clinical symptoms which these patients can present quite severe symptoms”, he concluded.
See the case presentation here.
