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Case Reports
. 2022 Jun;23(6):409.
doi: 10.3892/etm.2022.11336. Epub 2022 Apr 26.

Durable response after the discontinuation of pembrolizumab treatment due to an adverse event in a patient with advanced endometrial cancer: A case report

Shuntaro Umihira  1 , Takahiro Koyanagi  1 , Kohei Tamura  1 , Yoshifumi Takahashi  1 , Takahiro Yoshiba  1 , Suzuyo Takahashi  1 , Akiyo Taneichi  1 , Yasushi Saga  1 , Yuji Takei  1 , Hiroyuki Fujiwara  1
Affiliations
Case Reports

Durable response after the discontinuation of pembrolizumab treatment due to an adverse event in a patient with advanced endometrial cancer: A case report

Shuntaro Umihira et al. Exp Ther Med. 2022 Jun.

Abstract

The persistence of antitumor effects has been reported after the completion of treatment with immune checkpoint inhibitors (ICIs) for various types of carcinoma, such as malignant melanoma, exhibiting a durable response. A durable response has also been noted after the discontinuation of treatment at an early stage due to adverse events, including in renal pelvic cancer, pancreatic cancer and intrahepatic cholangiocarcinoma; however, to the best of our knowledge, a similar case report has not yet been published in the malignant gynecological tumor field. The present study described a patient with refractory advanced endometrial cancer in whom the administration of pembrolizumab was discontinued after the completion of the 7th course due to renal dysfunction; however, persistent tumor-reducing effects and decreases in the levels of tumor markers were noted for more than 18 months after the cessation of treatment. Pembrolizumab may be continuously administered to some patients for a long period, whereas a durable response is achieved by others even after its discontinuation at an early stage; therefore, difficulties are associated with selecting an appropriate duration of administration. Further studies are required to search for biomarkers that facilitate high-accuracy effect predictions, and to establish an optimal administration period in consideration of specific adverse reactions to ICIs and cost-effectiveness.

Keywords: durable response; endometrial cancer; gynecologic oncology; immune checkpoint inhibitor; pembrolizumab.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
(A) T2-weighed magnetic resonance imaging of the pelvis showed a uterine body tumor (arrowheads) invading the uterine cervix. (B) Computed tomography revealed pelvic lymph node metastases (arrowheads).
Figure 2
Figure 2
(A) Gross appearance of the uterine body tumor. The uterine cavity was occupied by a necrotic tumor invading the uterine cervix. (B) Histological examinations showed endometrioid carcinoma composed of more than 50% solid components, indicating grade 3. (C) Tumor cells had marked nuclear atypia with prominent nucleoli and mitosis. Magnification, (B) x100 and (C) x400.
Figure 3
Figure 3
Computed tomography findings revealed a durable response after the discontinuation of pembrolizumab monotherapy. (A) Right pelvic lymph node metastases after the AP regimen. (B) Right pelvic lymph node metastases after 7 cycles of pembrolizumab monotherapy. (C) Right pelvic lymph node metastases decreased in size 18 months after the discontinuation of pembrolizumab. Yellow crossed arrows indicate the metastatic pelvic lymph nodes. AP, doxorubicin and cisplatin.
See this image and copyright information in PMC

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