Kelly Wu W, Broman Kristy K, Brownie Evan R, Kauffmann Rondi M
*Vanderbilt University School of Medicine †Department of Surgery ‡Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN.
J Immunother. 2017 Jun;40(5):196-199. doi: 10.1097/CJI.0000000000000167.
Immune-related adverse events are common and well-documented in patients treated with ipilimumab, a cytotoxic T-lymphocyte antigen-4 monoclonal antibody approved for the treatment of metastatic and stage III melanoma. Neurological complications are rare, but widely variable and potentially devastating. Here, we discuss a case of a patient who was treated with a single dose of ipilimumab for resected stage III melanoma. She subsequently developed pandysautonomia that manifested as a tonically dilated pupil, gastrointestinal dysmotility, urinary retention, and profound orthostatic hypotension. Guillain-Barré syndrome was diagnosed on electromyography. She was treated with intravenous immunoglobulin, droxidopa, and supportive care, with prolonged but eventual recovery. Given the broadening use of ipilimumab in the treatment of advanced and metastatic melanoma, awareness and recognition of its profound immune-mediated adverse effects are essential.
免疫相关不良事件在接受伊匹木单抗治疗的患者中很常见且有充分记录，伊匹木单抗是一种获批用于治疗转移性和III期黑色素瘤的细胞毒性T淋巴细胞抗原4单克隆抗体。神经并发症罕见，但差异很大且可能具有毁灭性。在此，我们讨论一例接受单剂量伊匹木单抗治疗切除的III期黑色素瘤患者的病例。她随后出现了全自主神经功能不全，表现为瞳孔强直性扩张、胃肠动力障碍、尿潴留和严重的体位性低血压。肌电图检查诊断为吉兰-巴雷综合征。她接受了静脉注射免疫球蛋白、屈昔多巴和支持治疗，恢复过程漫长但最终康复。鉴于伊匹木单抗在晚期和转移性黑色素瘤治疗中的应用日益广泛，认识并识别其严重的免疫介导不良反应至关重要。
