Werner Jan-Michael, Schweinsberg Viola, Schroeter Michael, von Reutern Boris, Malter Michael P, Schlaak Max, Fink Gereon R, Mauch Cornelia, Galldiks Norbert
Department of Neurology, University of Cologne, Cologne, Germany.
Department of Dermatology, University of Cologne, Cologne, Germany.
Front Oncol. 2019 Feb 14;9:84. doi: 10.3389/fonc.2019.00084. eCollection 2019.
Currently, the blockade of certain immune checkpoints such as the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) using checkpoint inhibitors is standard of care in patients with metastatic melanoma, especially with BRAF wild-type. However, several checkpoint inhibitor-related complications have been reported, including severe adverse events in the central and peripheral nervous system. In particular, in the recent past, the occurrence of myasthenia gravis following checkpoint inhibitor monotherapy, particularly nivolumab or ipilimumab, has been reported. In contrast, reports on PD-1/CTLA-4 combination blockade-usually with fatal clinical outcome-are scarce. We here report a case with combination immune checkpoint blockade-related myasthenia gravis with favorable clinical outcome.
目前，使用检查点抑制剂阻断某些免疫检查点，如细胞毒性T淋巴细胞相关蛋白4（CTLA-4）和程序性细胞死亡蛋白1（PD-1），是转移性黑色素瘤患者，尤其是BRAF野生型患者的标准治疗方法。然而，已经报道了几种与检查点抑制剂相关的并发症，包括中枢和外周神经系统的严重不良事件。特别是，最近有报道称，在检查点抑制剂单药治疗后，尤其是纳武单抗或伊匹单抗治疗后，会发生重症肌无力。相比之下，关于PD-1/CTLA-4联合阻断（通常具有致命的临床结局）的报道很少。我们在此报告一例与联合免疫检查点阻断相关的重症肌无力病例，其临床结局良好。
