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Review
. 2023 Mar 28;10(4):ofad164.
doi: 10.1093/ofid/ofad164. eCollection 2023 Apr.

Cytomegalovirus Infections in Patients Treated With Immune Checkpoint Inhibitors for Solid Malignancies

Amalia Anastasopoulou  1 , Michael Samarkos  1 , Panagiotis Diamantopoulos  1 , Christina Vourlakou  2 , Dimitrios C Ziogas  1 , Pantelis Avramopoulos  1 , Panagiotis Kouzis  1 , John Haanen  3 , Helen Gogas  1
Affiliations
Review

Cytomegalovirus Infections in Patients Treated With Immune Checkpoint Inhibitors for Solid Malignancies

Amalia Anastasopoulou et al. Open Forum Infect Dis. .

Abstract

Cytomegalovirus (CMV) infection/disease has been repeatedly reported in patients treated with immune-checkpoint inhibitors (ICIs) and most commonly involves patients with relapsed/refractory (R/R) immune-related adverse events (irAEs). In the current study, we present a patient with melanoma who developed CMV gastritis during treatment with pembrolizumab in the absence of irAEs and without previous or current immunosuppression. Moreover, we review the literature regarding CMV infection/disease in patients treated with ICIs for solid malignancies. We present the currently available data on the pathogenesis, clinical characteristics, endoscopic findings, and histologic features and highlight the potential differences among cases complicating R/R irAEs versus those occurring in patients who are immunosuppression naive. Finally, we discuss the currently available data regarding potential useful diagnostic tools as well as the management of these patients.

Keywords: cytomegalovirus; immune-checkpoint inhibitors; immune-related adverse events; immune-related colitis; review.

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Conflict of interest statement

Potential conflicts of interest. PD reports personal fees from Novartis, Amgen, Janssen, and Roche. JH reports the following: financial compensation (to the institute) for advisory roles by Achilles Therapeutics, BioNTech, BMS, GSK, Immunocore, Iovance Bio, Instill Bio, Ipsen, MSD, Molecular Partners, Novartis, Pfizer, PokeAcel, Roche, Sanofi, and T-Knife; personal fees for advisory roles in Neogene Therapeutics, Scenic, grant support (all paid to the institute) by Amgen, Asher Bio, BioNTech, BMS, MSD, Novartis; and owner of stock options in Neogene Therapeutics. HG reports grants and personal fees from BMS and MSD and personal fees from Novartis, Pierre Fabre, Amgen, Sanofi/Regeneron, and Pfizer. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Histological examination images of our patient. (A) Fibropurulent material and gastric mucosa with acute inflammation suggestive of phlegmonous gastritis, initial biopsy (hematoxylin and eosin stain, ×100). (B) Immunohistochemistry (IHC) for cytomegalovirus (CMV) was performed retrospectively at the initial biopsy specimen (anti-CMV CCH2 + DDG9, Dako Omnis; Agilent). A CMV+ nuclei was identified (IHC, ×200). (C) Several positive nuclei for CMV on second biopsy, which was performed 3 months later (IHC, ×200). (D) Positive nuclei for CMV in third biopsy, performed 4 months later (IHC, ×200); cytoplasmic staining was not evaluated. (E and F) A fourth esophagogastroduodenoscopy was performed 2 months later, and IHC on multiple biopsy specimens revealed the presence of multiple CMV+ cells in one biopsy specimen (E) and absence in another (F).
See this image and copyright information in PMC

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