Tanaka Ryota, Fujisawa Yasuhiro, Sae Inoue, Maruyama Hiroshi, Ito Shusaku, Hasegawa Naoyuki, Sekine Ikuo, Fujimoto Manabu
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Department of Dermatology, Hitachi General Hospital, Ibaraki, Japan.
Jpn J Clin Oncol. 2017 Feb 11;47(2):175-178. doi: 10.1093/jjco/hyw167.
After 4 weeks of the last dose of nivolumab, a 59-year-old man with stage IV melanoma was subject to treatment with ipilimumab. After 5 weeks, the patient developed severe hepatitis, showing markedly elevated levels of both aspartate aminotransferase and alanine aminotransferase (>2000 U/l). Using pulse steroid therapy with 1000 mg/d of methylprednisolone, liver function initially improved, but then deteriorated upon dosage reduction. Subsequently, mycophenolate mofetil (MMF) was administered at a dose of 2 g/d in addition to the corticosteroid, which resulted in aspartate aminotransferase and alanine aminotransferase levels gradually improving to grade 1, and the corticosteroid dose was successfully reduced to 0.5 mg/kg/d of oral prednisolone. Liver function then remained stable when MMF was tapered. In conclusion, the use of MMF improved liver function in this patient with steroid-refractory hepatitis induced by immune checkpoint inhibitor administration.
在最后一剂纳武单抗治疗4周后，一名59岁的IV期黑色素瘤男性患者接受了伊匹单抗治疗。5周后，患者出现严重肝炎，天冬氨酸转氨酶和丙氨酸转氨酶水平均显著升高（>2000 U/L）。采用1000 mg/d甲泼尼龙进行脉冲类固醇治疗，肝功能最初有所改善，但在减量时恶化。随后，除皮质类固醇外，还给予霉酚酸酯（MMF），剂量为2 g/d，这使得天冬氨酸转氨酶和丙氨酸转氨酶水平逐渐改善至1级，皮质类固醇剂量成功减至口服泼尼松龙0.5 mg/kg/d。当MMF逐渐减量时，肝功能保持稳定。总之，MMF的使用改善了该免疫检查点抑制剂诱导的类固醇难治性肝炎患者的肝功能。
