Nomura Hisashi, Takahashi Hayato, Suzuki Satsuki, Kurihara Yuichi, Chubachi Shotaro, Kawada Ichiro, Yasuda Hiroyuki, Betsuyaku Tomoko, Amagai Masayuki, Funakoshi Takeru
Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
J Dermatol. 2017 Jul;44(7):818-821. doi: 10.1111/1346-8138.13810. Epub 2017 Mar 11.
Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Although these agents induce antitumor immunity against melanoma, the modified immune condition may result in an unexpected adverse reaction which has not been observed previously. Herein, we report a case who manifested severe erythema multiforme-like eruption with mucosal involvement associated with vemurafenib following nivolumab. The patient also subsequently suffered from ipilimumab-induced interstitial pneumonia with refractory course. Such a case has never been reported. This case suggested that dermatologists should pay special attention to unexpected adverse events of these drugs, and carefully observe cutaneous and respiratory status of patients during the treatment of melanoma.
维莫非尼可提高黑色素瘤患者的生存率。然而，这些患者中常见皮肤副作用。纳武单抗和伊匹单抗是分别针对程序性死亡蛋白1和细胞毒性T淋巴细胞相关抗原4的单克隆抗体，二者均调节过度的T细胞活化。尽管这些药物可诱导针对黑色素瘤的抗肿瘤免疫，但免疫状态的改变可能导致以前未观察到的意外不良反应。在此，我们报告1例在接受纳武单抗治疗后出现与维莫非尼相关的伴有黏膜受累的重症多形红斑样皮疹的病例。该患者随后还罹患伊匹单抗诱导的间质性肺炎且病程难治。此类病例此前从未有过报道。该病例提示皮肤科医生应特别关注这些药物的意外不良事件，并在黑色素瘤治疗期间仔细观察患者的皮肤和呼吸状况。
