Maeda Osamu, Yokota Kenji, Atsuta Naoki, Katsuno Masahisa, Akiyama Masashi, Ando Yuichi
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan.
Department of Dermatology, Nagoya University Graduate School of Medicine Nagoya, Japan.
Nagoya J Med Sci. 2016 Feb;78(1):119-22.
A 79-year-old man with lymph node recurrence of malignant melanoma received nivolumab, an anti-programmed death 1 (PD-1) monoclonal antibody. He had pre-existing ocular myasthenia gravis (MG) and a continued small amount of corticosteroid. Grade 3 creatine phosphokinase elevation appeared after two doses of nivolumab, and the treatment was postponed until it improved to grade 1. After three doses of nivolumab, he experienced diplopia and facial muscle weakness which were consistent with an acute exacerbation of MG, and the symptoms relieved without additional treatment for MG. He achieved shrinkage of metastasis after ten doses of nivolumab. Although a case who died due to MG after administration of nivolumab was reported recently, pre-existing MG is considered not to be always a contraindication of nivolumab.
一名79岁的恶性黑色素瘤淋巴结复发男性接受了纳武单抗治疗，纳武单抗是一种抗程序性死亡1（PD-1）单克隆抗体。他既往患有眼肌型重症肌无力（MG），并持续使用少量皮质类固醇。在使用两剂纳武单抗后出现3级肌酸磷酸激酶升高，治疗推迟至改善至1级。在使用三剂纳武单抗后，他出现复视和面部肌肉无力，这与MG急性加重一致，且症状在未接受MG额外治疗的情况下缓解。在使用十剂纳武单抗后，他的转移灶缩小。尽管最近有报道称有一例患者在使用纳武单抗后因MG死亡，但既往患有MG并不总是被视为纳武单抗的禁忌证。
