新墨西哥州退伍军人事务医疗中心罕见免疫介导的不良反应系列病例

Kenneth M Zabel, Lauren Tagliaferro-Epler, Coty Ho, Marissa Tafoya, Michael Reyes, Vishal Vashistha
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引用次数: 0

摘要

背景:免疫检查点抑制剂(ICI)疗法已经彻底改变了几种实体肿瘤的治疗。随着越来越多的适应症被美国食品和药物管理局批准使用,以及癌症患者数量的增加,预计ICIs的使用将会增加。不幸的是,ici与免疫介导的不良反应(IMARs)的发生有关。约5%至10%的患者出现严重毒性,需要推迟或停药。imar可以影响任何器官,但最常见的是涉及皮肤和内分泌腺。病例报告:我们报告了在新墨西哥州退伍军人事务医疗中心观察到的一系列imar病例。首先,我们报告一名84岁男性,因肺腺癌而接受化学免疫治疗的4级心肌炎病例,以证明这种罕见疾病的快速进展。其次,我们报告一例葡萄膜炎患者,70岁男性浅表性膀胱癌患者接受派姆单抗治疗。最后,我们报告了一例63岁男性胸膜炎和组织性肺炎继发于双ICI治疗间皮瘤(纳伏单抗和伊匹单抗)。讨论了这些IMARs的流行病学、预期病程和最佳管理,然后描述了每种罕见毒性。结论:尽管这些毒性并不常见,但它们提醒了各专业的临床医生,IMARs可导致任何器官的急性恶化,对于任何病因不明的非典型表现,应考虑继发于ICIs的毒性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Case Series of Rare Immune-Mediated Adverse Reactions at the New Mexico Veterans Affairs Medical Center.

Background: Immune checkpoint inhibitor (ICI) therapy has revolutionized the treatment of several solid tumors. The use of ICIs is expected to rise as a growing number of indications are approved for their use by the US Food and Drug Administration and with the increasing number of patients with cancer. Unfortunately, ICIs are associated with the development of immune-mediated adverse reactions (IMARs). About 5% to 10% of patients developing severe toxicities requiring treatment postponement or discontinuation. IMARs can affect any organ, but most frequently the skin and endocrine glands are involved.

Case presentation: We present a case series of IMARs observed at the New Mexico Veterans Affairs Medical Center. First, we present a case of grade 4 myocarditis in an 84-year-old man receiving chemoimmunotherapy for lung adenocarcinoma to demonstrate the rapid progression of this rare condition. Second, we present a case of uveitis in a 70-year-old man with superficial bladder cancer undergoing treatment with pembrolizumab. Finally, we present a case of a 63-year-old man with pleuritis and organizing pneumonia secondary to dual ICI treatment (nivolumab and ipilimumab) for mesothelioma. A discussion regarding the epidemiology of these IMARs, expected course, and optimal management follows each rare toxicity described.

Conclusions: Though these toxicities are uncommon, they serve as a reminder to clinicians across specialties that IMARs can drive the acute deterioration of any organ, and consideration of toxicities secondary to ICIs should be considered for any atypical presentation of unclear etiology.

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