Ito Jiro, Fujimoto Daichi, Nakamura Ayaka, Nagano Tohru, Uehara Keiichiro, Imai Yukihiro, Tomii Keisuke
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Lung Cancer. 2017 Jul;109:58-61. doi: 10.1016/j.lungcan.2017.04.020. Epub 2017 Apr 27.
Although substantial progress has been made in the treatment of non-small-cell lung cancer (NSCLC) patients with immune checkpoint inhibitors (ICIs), severe immune-related adverse events (irAEs) sometimes occur. Here, we report a case of severe refractory pruritus after Stevens-Johnson syndrome (SJS) in a patient with NSCLC treated with nivolumab. The patient was a 76-year-old Japanese woman with advanced NSCLC treated with nivolumab. After the second dose, she experienced severe rash with mucous involvement. We diagnosed SJS and started 50mg of oral prednisolone (1mg/kg). The rash completely resolved after prednisolone was started, but we could not manage the severe pruritus with emollients, antihistamines, and steroids. Finally, we administered aprepitant, an oral neurokinin-1 receptor antagonist, for her refractory pruritus. Her symptoms improved within 5days. Severe refractory pruritus can arise from ICIs, and aprepitant may be a useful treatment.
尽管在使用免疫检查点抑制剂（ICI）治疗非小细胞肺癌（NSCLC）患者方面已取得了重大进展，但严重的免疫相关不良事件（irAE）有时仍会发生。在此，我们报告一例接受纳武单抗治疗的NSCLC患者在发生史蒂文斯-约翰逊综合征（SJS）后出现严重难治性瘙痒的病例。该患者是一名76岁的日本女性，患有晚期NSCLC，接受纳武单抗治疗。在第二次给药后，她出现了伴有黏膜受累的严重皮疹。我们诊断为SJS，并开始口服50毫克泼尼松龙（1毫克/千克）。开始使用泼尼松龙后皮疹完全消退，但我们无法用润肤剂、抗组胺药和类固醇控制严重的瘙痒。最后，我们给她使用了阿瑞匹坦，一种口服神经激肽-1受体拮抗剂，用于治疗她的难治性瘙痒。她的症状在5天内得到改善。ICI可能会引发严重难治性瘙痒，阿瑞匹坦可能是一种有效的治疗方法。
