Clinical Scorecard: Non-infectious cystitis as a complication of toripalimab therapy in a patient with alpha-fetoprotein-producing gastric adenocarcinoma: a case study

At a Glance

Key Highlights

• Case of non-bacterial cystitis leading to acute kidney injury in a patient treated with toripalimab.
• Cystoscopy revealed diffuse mucosal hemorrhage and extensive lymphocyte infiltration.
• Full-dose methylprednisolone effectively alleviated symptoms and restored renal function.
• Emphasizes the need for vigilance regarding urinary system irAEs in ICI therapy.
• Provides insights into immunotherapy practice and toxicity management in AFP-GC.

Guideline-Based Recommendations

Diagnosis

• Diagnosis based on clinical presentation, imaging findings, cystoscopic appearance, and pathology data.

Management

• Full-dose corticosteroids should be used for moderate to severe immune-related adverse events.

Monitoring & Follow-up

• Monitor for urinary tract irritation symptoms and renal function in patients receiving ICIs.

Risks

• Increased incidence of immune-related adverse events when ICIs are used with chemotherapy.

Patient & Prescribing Data

59-year-old male with advanced alpha-fetoprotein-producing gastric carcinoma.

Combination of toripalimab and SOX chemotherapy led to significant immune-related side effects.

Clinical Best Practices

• Early identification and systematic evaluation of immune-related adverse events are critical.
• Consider referral to Urology for cystoscopy and biopsy in cases of suspected irAEs affecting the urinary system.

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