检查点抑制剂Cemiplimab诱导的Vogt Koyanagi Harada样综合征。

IF 3.2 4区 医学 Q3 IMMUNOLOGY
Journal of Immunotherapy Pub Date : 2023-10-01 Epub Date: 2023-05-26 DOI:10.1097/CJI.0000000000000476
Ye Huang, Farid Khan, Nehali V Saraiya, Omar S Punjabi, Vikas Gulati, Alan R Erickson, Steven Yeh
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引用次数: 0

摘要

靶向程序性细胞死亡蛋白1的检查点抑制已证明对包括皮肤恶性肿瘤在内的广泛适应症有效。然而,免疫相关不良事件(irAE),包括罕见但对视觉有影响的眼部irAE,需要仔细考虑治疗方案,包括停药、局部皮质类固醇或很少进行免疫调节。该病例为一名53岁的女性,在用程序性细胞死亡蛋白1抑制剂西米普利单抗治疗多种皮肤肿瘤(主要是鳞状细胞癌)后,出现葡萄膜炎和粘膜溃疡。眼科检查显示弥漫性脉络膜色素脱失符合Vogt Koyanagi Harada样综合征。使用局部和眼周类固醇治疗眼内炎症,并停用西咪咪单抗。由于持续的严重葡萄膜炎,开始了全身皮质类固醇和保留皮质类固醇的免疫抑制。具体而言,引入了硫唑嘌呤和甲氨蝶呤,但由于副作用,每种药物都被停止,促使阿达木单抗(ADA)治疗开始。虽然ADA控制了眼内炎症,但鳞状细胞癌进展缓慢,导致ADA停用。然而,观察到葡萄膜炎复发。在讨论了生物免疫抑制治疗的风险和益处(包括视力丧失的风险)后,在16个月的随访中,ADA被重新启动,并成功地使疾病平静下来。皮肤肿瘤采用局部和病灶内治疗,如5-氟尿嘧啶。最近的皮肤科检查显示没有新的皮肤病变。这种情况表明ADA在眼部irAE中的有效使用,平衡了威胁视力的眼部炎症的管理与促进复发或新发肿瘤疾病的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab.

Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab.

Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab.

Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab.

Checkpoint inhibition targeting programmed cell-death protein 1 has demonstrated efficacy for a wide range of indications including cutaneous malignancy. However, immune-related adverse events (irAEs), including infrequent but visually impactful ocular irAEs, require careful consideration of treatment options, including medication withdrawal, local corticosteroids, or rarely immunomodulation. This case presents a 53-year-old woman who developed uveitis and mucous membrane ulcers after treatment for numerous cutaneous neoplasms, primarily squamous cell carcinoma, with the programmed cell-death protein 1 inhibitor cemiplimab. Ophthalmic examination revealed diffuse choroidal depigmentation consistent with a Vogt-Koyanagi-Harada-like syndrome. Topical and periocular steroids were used to treat the intraocular inflammation, and cemiplimab was discontinued. Because of ongoing severe uveitis, systemic corticosteroids and corticosteroid-sparing immunosuppression were initiated. Specifically, azathioprine and methotrexate were introduced, but each was stopped due to side effects, prompting the initiation of adalimumab (ADA) treatment. While ADA controlled intraocular inflammation, the squamous cell carcinomas were noted to progress, resulting in the discontinuation of ADA. However, a uveitis recurrence was observed. After a discussion of risks and benefits of biologic immunosuppressive therapy, including the risk of vision loss, ADA was restarted with successful disease quiescence at a 16-month follow-up. The cutaneous neoplasms were managed with topical and intralesional therapies, such as 5-fluorouracil. Recent dermatologic examinations suggested no new cutaneous lesions. This scenario presents the effective use of ADA in an ocular irAE that balances the management of sight-threatening ocular inflammation with the risk of promoting recurrent or de novo neoplastic disease.

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来源期刊
Journal of Immunotherapy
Journal of Immunotherapy 医学-免疫学
CiteScore
6.90
自引率
0.00%
发文量
79
审稿时长
6-12 weeks
期刊介绍: Journal of Immunotherapy features rapid publication of articles on immunomodulators, lymphokines, antibodies, cells, and cell products in cancer biology and therapy. Laboratory and preclinical studies, as well as investigative clinical reports, are presented. The journal emphasizes basic mechanisms and methods for the rapid transfer of technology from the laboratory to the clinic. JIT contains full-length articles, review articles, and short communications.
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