Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA.
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1374, 1155 Pressler Street, Houston, TX 77030-3721 USA.
J Immunother Cancer. 2016 Jun 21;4:36. doi: 10.1186/s40425-016-0139-8. eCollection 2016.
Immune checkpoint inhibitors have revolutionized cancer therapy since these drugs target inhibitory pathways on T cells, which result in durable anti-tumor immune responses and significant overall survival for a subset of cancer patients. These drugs can also lead to toxicities, which require additional research to identify mechanisms of toxicities and biomarkers that can help to identify patients who will develop immune-related adverse events.
We describe the first case, to our knowledge, of a patient with metastatic urothelial carcinoma who developed acute rhabdomyolysis with severe polymyositis after treatment with combination immunotherapy consisting of ipilimumab plus nivolumab (Trial registration: NCT01928394. Registered: 8/21/2013). We found that this patient had an elevated pre-existing anti-striated muscle antibody titer, which was likely exacerbated with the immunotherapy treatment thereby resulting in the presentation of acute rhabdomyolysis and severe polymyositis.
This case suggests that immune-related adverse events may be linked to subclinical autoimmune conditions which highlights the need for additional studies to identify patients who are at risk for toxicities.
自免疫检查点抑制剂问世以来，癌症治疗领域发生了革命性变化。这些药物的作用靶点是 T 细胞上的抑制性通路，能够引发持久的抗肿瘤免疫反应，并显著提高部分癌症患者的总生存率。然而，这些药物也会引发毒副作用，因此需要进一步研究，以明确其毒性作用机制和生物标志物，从而帮助识别可能发生免疫相关不良反应的患者。
我们报告了首例转移性尿路上皮癌患者的病例，该患者在接受伊匹单抗联合纳武单抗（Trial registration：NCT01928394. Registered：8/21/2013）联合免疫治疗后发生急性横纹肌溶解症伴严重多发性肌炎。我们发现该患者存在预先存在的抗横纹肌抗体滴度升高，这可能与免疫治疗有关，导致急性横纹肌溶解症和严重多发性肌炎的发生。
该病例提示免疫相关不良反应可能与亚临床自身免疫状况有关，这强调了需要进一步研究来识别有发生毒性风险的患者。
