Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab

Manuel A. Baarslag; Joosje H. Heimovaara; Jessica S.W. Borgers; Koen J. Van Aerde; Hans J.P.M. Koenen; Ruben L. Smeets; Pauline L.M. Buitelaar; Dick Pluim; Shoko Vos; Stefanie S.V. 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; Nicole Gierenz

doi:10.1056/NEJMoa2308135

Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab

Manuel A. Baarslag, Joosje H. Heimovaara, Jessica S.W. Borgers, Koen J. Van Aerde, Hans J.P.M. Koenen, Ruben L. Smeets, Pauline L.M. Buitelaar, Dick Pluim, Shoko Vos, Stefanie S.V. 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^*, Nicole Gierenz

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Summary 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.

Original language	English
Pages (from-to)	1790-1796
Number of pages	7
Journal	New England Journal of Medicine
Volume	389
Issue number	19
DOIs	https://doi.org/10.1056/NEJMoa2308135
Publication status	Published - 9 Nov 2023

Keywords

Allergy/Immunology
Autoimmune Disease
Complications of Pregnancy
Gastroenterology
Hematology/Oncology
Inflammatory Bowel Disease
Neonatology
Obstetrics/Gynecology
Obstetrics/Gynecology General
Pediatrics
Treatments in Oncology

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Baarslag, M. A., Heimovaara, J. H., Borgers, J. S. W., Van Aerde, K. J., Koenen, H. J. P. M., Smeets, R. L., Buitelaar, P. L. M., Pluim, D., Vos, S., Henriet, S. S. V., De Groot, J. W. B., Van Grotel, M., Rosing, H., Beijnen, J. H., Huitema, A. D. R., Haanen, J. B. A. G., Amant, F., & Gierenz, N. (2023). Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab. New England Journal of Medicine, 389(19), 1790-1796. https://doi.org/10.1056/NEJMoa2308135

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title = "Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab",

abstract = "Summary 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.",

keywords = "Allergy/Immunology, Autoimmune Disease, Complications of Pregnancy, Gastroenterology, Hematology/Oncology, Inflammatory Bowel Disease, Neonatology, Obstetrics/Gynecology, Obstetrics/Gynecology General, Pediatrics, Treatments in Oncology",

author = "Baarslag, {Manuel A.} and Heimovaara, {Joosje H.} and Borgers, {Jessica S.W.} and {Van Aerde}, {Koen J.} and Koenen, {Hans J.P.M.} and Smeets, {Ruben L.} and Buitelaar, {Pauline L.M.} and Dick Pluim and Shoko Vos and Henriet, {Stefanie S.V.} and {De Groot}, {Jan Willem B.} and {Van Grotel}, Martine and Hilde Rosing and Beijnen, {Jos H.} and Huitema, {Alwin D.R.} and Haanen, {John B.A.G.} and Fr{\'e}d{\'e}ric Amant and Nicole Gierenz",

note = "Publisher Copyright: {\textcopyright} 2023 Massachusetts Medical Society.",

year = "2023",

month = nov,

day = "9",

doi = "10.1056/NEJMoa2308135",

language = "English",

volume = "389",

pages = "1790--1796",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "19",

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Baarslag, MA, Heimovaara, JH, Borgers, JSW, Van Aerde, KJ, Koenen, HJPM, Smeets, RL, Buitelaar, PLM, Pluim, D, Vos, S, Henriet, SSV, De Groot, JWB, Van Grotel, M, Rosing, H, Beijnen, JH, Huitema, ADR, Haanen, JBAG, Amant, F & Gierenz, N 2023, 'Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab', New England Journal of Medicine, vol. 389, no. 19, pp. 1790-1796. https://doi.org/10.1056/NEJMoa2308135

TY - JOUR

T1 - Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab

AU - Baarslag, Manuel A.

AU - Heimovaara, Joosje H.

AU - Borgers, Jessica S.W.

AU - Van Aerde, Koen J.

AU - Koenen, Hans J.P.M.

AU - Smeets, Ruben L.

AU - Buitelaar, Pauline L.M.

AU - Pluim, Dick

AU - Vos, Shoko

AU - Henriet, Stefanie S.V.

AU - De Groot, Jan Willem B.

AU - Van Grotel, Martine

AU - Rosing, Hilde

AU - Beijnen, Jos H.

AU - Huitema, Alwin D.R.

AU - Haanen, John B.A.G.

AU - Amant, Frédéric

AU - Gierenz, Nicole

PY - 2023/11/9

Y1 - 2023/11/9

N2 - Summary 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.

AB - Summary 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.

KW - Allergy/Immunology

KW - Autoimmune Disease

KW - Complications of Pregnancy

KW - Gastroenterology

KW - Hematology/Oncology

KW - Inflammatory Bowel Disease

KW - Neonatology

KW - Obstetrics/Gynecology

KW - Obstetrics/Gynecology General

KW - Pediatrics

KW - Treatments in Oncology

UR - http://www.scopus.com/inward/record.url?scp=85176332842&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa2308135

DO - 10.1056/NEJMoa2308135

M3 - Article

C2 - 37937778

AN - SCOPUS:85176332842

SN - 0028-4793

VL - 389

SP - 1790

EP - 1796

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 19

ER -

Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab

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