{"title":"Amyopathic dermatomyositis associated with immune checkpoint inhibitor therapy in lung adenocarcinoma: a case report.","authors":"Zhang Zhang, Takehiro Uemura, Pengyi Guo","doi":"10.21037/tcr-2024-2364","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have proven efficacious in various types of cancers, including lung cancer, but they usually lead to a set of organ-specific immune-related adverse events (irAEs). In particular, checkpoint inhibitor pneumonitis (CIP) requires special attention because it is difficult to diagnose and can be potentially fatal. Accumulating real-world epidemiological data indicate that CIP is more common than previously reported. Amyopathic dermatomyositis (ADM), which shows no or minimal muscle damage, is positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5) and involves unique skin findings, as well as clinical features of rapidly progressive interstitial lung disease (RP-ILD). Therefore, knowing how to differentiate between CIP and ADM-related RP-ILD is important, which can provide valuable experience for subsequent treatment of patients.</p><p><strong>Case description: </strong>We report a case of a patient with stage IV lung adenocarcinoma who developed ADM associated with RP-ILD following the administration of pembrolizumab, an inhibitor of the programmed cell death 1 (PD-1) pathway. The principal adverse reactions to pembrolizumab are irAEs. However, pembrolizumab-associated ADM has not been previously reported in clinical settings. The patient presented with atypical skin lesions and tested positive for anti-MDA5 antibodies, accompanied by severe acute ILD.</p><p><strong>Conclusions: </strong>We believe this case represents a valuable clinical reference for the future management of irAEs caused by pembrolizumab and emphasizes the necessity of early screening for anti-melanoma differentiation associated protein 5 (MDA5) antibodies in patients with CIP presenting as RP-ILD.</p>","PeriodicalId":23216,"journal":{"name":"Translational cancer research","volume":"14 2","pages":"1500-1505"},"PeriodicalIF":1.5000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912058/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational cancer research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tcr-2024-2364","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/26 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Immune checkpoint inhibitors (ICIs) have proven efficacious in various types of cancers, including lung cancer, but they usually lead to a set of organ-specific immune-related adverse events (irAEs). In particular, checkpoint inhibitor pneumonitis (CIP) requires special attention because it is difficult to diagnose and can be potentially fatal. Accumulating real-world epidemiological data indicate that CIP is more common than previously reported. Amyopathic dermatomyositis (ADM), which shows no or minimal muscle damage, is positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5) and involves unique skin findings, as well as clinical features of rapidly progressive interstitial lung disease (RP-ILD). Therefore, knowing how to differentiate between CIP and ADM-related RP-ILD is important, which can provide valuable experience for subsequent treatment of patients.
Case description: We report a case of a patient with stage IV lung adenocarcinoma who developed ADM associated with RP-ILD following the administration of pembrolizumab, an inhibitor of the programmed cell death 1 (PD-1) pathway. The principal adverse reactions to pembrolizumab are irAEs. However, pembrolizumab-associated ADM has not been previously reported in clinical settings. The patient presented with atypical skin lesions and tested positive for anti-MDA5 antibodies, accompanied by severe acute ILD.
Conclusions: We believe this case represents a valuable clinical reference for the future management of irAEs caused by pembrolizumab and emphasizes the necessity of early screening for anti-melanoma differentiation associated protein 5 (MDA5) antibodies in patients with CIP presenting as RP-ILD.
期刊介绍:
Translational Cancer Research (Transl Cancer Res TCR; Print ISSN: 2218-676X; Online ISSN 2219-6803; http://tcr.amegroups.com/) is an Open Access, peer-reviewed journal, indexed in Science Citation Index Expanded (SCIE). TCR publishes laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer; results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of cancer patients. The focus of TCR is original, peer-reviewed, science-based research that successfully advances clinical medicine toward the goal of improving patients'' quality of life. The editors and an international advisory group of scientists and clinician-scientists as well as other experts will hold TCR articles to the high-quality standards. We accept Original Articles as well as Review Articles, Editorials and Brief Articles.