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Immune checkpoint inhibitor esophagitis with excellent response to oral viscous budesonide

Year: 2025

Type: article

Abstract: Immune checkpoint inhibitors (ICIs) are increasingly utilised in the treatment of advanced malignancies. ICIs can result in a wide array of immune-related adverse events of which gastrointestinal toxicities are common. We present a 52-year-old female with severe dysphagia and heartburn despite proton pump inhibitor therapy whilst receiving pembrolizumab for breast cancer. A diagnosis of ICI esophagitis was made following gastroscopy with esophageal specimens when combined with the patients’ symptoms and immunotherapy exposure. Pembrolizumab was discontinued and she was treated with oral viscous budesonide which has proven efficacy in eosinophilic esophagitis but is not well established in treatment of ICI-related esophagitis. There was an impressive response to oral viscous budesonide, and this avoided the need for systemic immunosuppression. This is the first case in the literature to describe the presentation, treatment protocol and outcome for a patient treated with oral viscous budesonide for ICI-related esophagitis.

Source: Current Problems in Cancer Case Reports

DOI: 10.1016/j.cpccr.2025.100387

Authors: McCawley Clark-Dickson, Alireza Khani, T․Michael Hughes, Graeme Rich, Kazi Nahar

Institutions: Australian National University, Sydney Adventist Hospital, Douglass Hanly Moir Pathology

Language: English

Topic: Cancer Immunotherapy and Biomarkers

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,030