Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Neuroradiology Section, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Immunol Res. 2015 Jun;3(6):598-601. doi: 10.1158/2326-6066.CIR-15-0035. Epub 2015 Apr 28.
Ipilimumab, an anticytotoxic T-lymphocyte antigen (CTLA)-4 monoclonal antibody, is a first-line therapy for stage IV melanoma. Although high-grade immune-related adverse events occur in 25% of patients receiving ipilimumab, serious neurologic toxicity, primarily consisting of transient sensory and motor neuropathies, affects less than 1% of patients. We present a case report of a patient with melanoma who received high-dose ipilimumab at 10 mg/kg as first-line therapy for metastatic disease. After the third dose, the patient developed "mild" encephalopathy with a reversible splenial lesion (MERS) of the corpus callosum by MRI and neurogenic bladder, two novel immune-related adverse events during checkpoint inhibition. In addition to headache, delirium, and altered consciousness commonly seen with MERS, the patient also developed tremor, gait instability, paresthesias, and neurogenic bladder. The latter two symptoms were thought to represent sensory and autonomic neuropathies, respectively. The syndrome gradually resolved following intravenous methylprednisolone at 2 mg/kg divided twice daily for 5 days and a slow taper of oral prednisone over 8 weeks.
伊匹单抗(ipilimumab)是一种抗细胞毒性 T 淋巴细胞相关抗原（CTLA-4）的单克隆抗体，是治疗 IV 期黑色素瘤的一线药物。尽管接受伊匹单抗治疗的患者中有 25%会发生高级别免疫相关不良事件，但严重的神经系统毒性，主要包括短暂的感觉和运动性神经病，影响不到 1%的患者。我们报告了一例黑色素瘤患者的病例，该患者接受了 10mg/kg 的高剂量伊匹单抗作为转移性疾病的一线治疗。在接受第三剂治疗后，该患者通过 MRI 检查出了脑白质可逆性后部脑病综合征（MERS）和神经源性膀胱炎，这两种都是在检查点抑制期间出现的新型免疫相关不良事件。除了常见的 MERS 相关头痛、意识混乱和意识改变外，该患者还出现了震颤、步态不稳、感觉异常和神经源性膀胱炎。后两种症状分别被认为代表感觉和自主神经病。该综合征在静脉注射 2mg/kg 甲泼尼龙（每日两次，共 5 天）和 8 周内逐渐减少口服泼尼松剂量后逐渐缓解。
