Schneider Stephanie, Potthast Silke, Komminoth Paul, Schwegler Guido, Böhm Steffen
Department of Internal Medicine, Oncology/Hematology, Limmattal Hospital Zurich, Schlieren, Switzerland.
Department of Radiology, Limmattal Hospital Zurich, Schlieren, Switzerland.
Case Rep Oncol. 2017 May 24;10(2):473-478. doi: 10.1159/000477162. eCollection 2017 May-Aug.
To report first-hand narrative experience of autoimmune encephalitis and to briefly review currently available evidence of autoimmune encephalitis in cancer patients treated with immune checkpoint inhibitors.
A case study is presented on the management of a patient who developed autoimmune encephalitis during nivolumab monotherapy occurring after 28 weeks on anti-PD-1 monotherapy (nivolumab 3 mg/kg every 2 weeks) for non-small cell lung cancer.
No substantial improvement was observed by antiepileptic treatment. After administration of 80 mg methylprednisolone, neurologic symptoms disappeared within 24 h and the patient fully recovered.
Immune checkpoint inhibitor treatment can lead to autoimmune encephalitis. Clinical trial data indicate a frequency of autoimmune encephalitis of ≥0.1 to <1% with a higher probability during combined or sequential anti-CTLA-4/anti-PD-1 therapy than during anti-PD-1 or anti-PD-L1 monotherapy. Further collection of evidence and translational research is warranted.
报告自身免疫性脑炎的第一手叙述性经验，并简要回顾目前关于接受免疫检查点抑制剂治疗的癌症患者发生自身免疫性脑炎的现有证据。
本文介绍了一例非小细胞肺癌患者在接受抗程序性死亡蛋白1（PD-1）单药治疗（纳武利尤单抗3mg/kg，每2周一次）28周后出现自身免疫性脑炎的管理案例。
抗癫痫治疗未观察到明显改善。给予80mg甲泼尼龙后，神经症状在24小时内消失，患者完全康复。
免疫检查点抑制剂治疗可导致自身免疫性脑炎。临床试验数据表明，自身免疫性脑炎的发生率≥0.1%至<1%，联合或序贯抗细胞毒性T淋巴细胞相关蛋白4（CTLA-4）/抗PD-1治疗期间发生的可能性高于抗PD-1或抗程序性死亡配体1（PD-L1）单药治疗期间。有必要进一步收集证据并开展转化研究。
