A new French case report shines a spotlight on a little-known potential complication of mesothelioma immunotherapy: celiac disease.
Celiac disease is a chronic digestive and immune disorder brought on by sensitivity to gluten. Over time, celiac disease damages the small intestine causing long-lasting digestive problems. It can prevent patients from getting the nutrients they need to stay healthy.
The new case report appears in Frontiers in Immunology. It details the case of a 70-year-old man who developed celiac disease after treatment with nivolumab. The case suggests that celiac disease may be an underrecognized side effect of mesothelioma immunotherapy.
It is a reminder for mesothelioma patients and doctors to pay close attention to digestive problems after treatment.
Stimulating the Immune System to Fight Cancer
Standard cancer treatments rarely extend mesothelioma survival by more than a few months. This has forced mesothelioma researchers to look elsewhere for answers. Mesothelioma immunotherapy is considered one of the most promising new approaches to this intractable malignancy.
Immunotherapy uses the power of patients’ own immune systems to fight their cancer.
In 2020, the FDA approved two immune checkpoint inhibitors (ICIs) for pleural mesothelioma. The drugs are nivolumab (Opdivo) and ipilimumab (Yervoy). One of these drugs increases the number of cancer-killing immune cells in a mesothelioma tumor. The other drug alters mesothelioma cells to make them more susceptible to attack.
Three years after the last mesothelioma patients enrolled in the mesothelioma immunotherapy trial of these two drugs, nearly a quarter were still alive. Most mesothelioma patients do not live more than a year after diagnosis.
Mesothelioma Immunotherapy Can Cause Side Effects
Manipulating the immune system is not without risk. The American Society for Clinical Oncology says the side effects of mesothelioma immunotherapy can range from mild to life-threatening.
Common side effects of immune checkpoint inhibitors like Yervoy and Opdivo include:
- Rashes & itching
- Joint pain and/or swelling
- Nervous system problems
- Lung inflammation
- Thyroid disorders
But there may be another one to add to the list. The patient in the French case study was on nivolumab when he developed diarrhea. Further testing showed he had celiac disease. Doctors gave him steroids to calm his immune system and put him on a gluten free diet. Unfortunately, this patient’s case may not be unique.
“Increasing reports suggest that celiac disease might represent an underestimated ICI toxicity,” writes first author Julie Leblanc, a medical oncologist at Aix-Marseille University.
The team cautions cancer doctors to monitor unusual gastrointestinal symptoms in patients on mesothelioma immunotherapy.
“This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy,” writes Leblanc.
Leblanc, J, et al, “Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report”, December 17, 2021, Frontiers in Immunology, https://www.frontiersin.org/articles/10.3389/fimmu.2021.799666/full