Wang Qingqing, Hu Bijie
Department of Infectious Diseases, Hospital Infection Management, Zhongshan Hospital of Fudan University, Shanghai 200032, China.
Ann Transl Med. 2019 Jun;7(11):247. doi: 10.21037/atm.2019.04.73.
Immune checkpoint inhibitors (ICIs), including inhibitors of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) have demonstrated prominent clinical benefits in a variety of cancers and have been rapidly applied to treat a variety of carcinomas such as melanoma, non-small-cell lung cancer, and head and neck cancer. Meanwhile, the occurrence of immune-related adverse events (irAEs) has been increasing. In this case, we report a 45-year-old man with metastatic nasopharyngeal carcinoma suffering from pulmonary fibrosis and myocarditis on the 4th day after receiving pembrolizumab treatment which belongs to anti-PD-1 drugs. Although the endomyocardial biopsy (EMB) could not be performed, the strong temporal association with pembrolizumab treatment and the specific changes of electrocardiograph, echocardiography and cardiovascular magnetic resonance (CMR) suggest that the myocardial injury and edema were related to pembrolizumab-induced myocarditis. With glucocorticoid treatment, the symptoms and myocardium lesion were almost resolved and the patient agreed to tapered chemotherapy with steroid treatment.
免疫检查点抑制剂（ICIs），包括细胞毒性T淋巴细胞相关抗原4（CTLA-4）抑制剂、程序性死亡蛋白1（PD-1）抑制剂和程序性死亡配体1（PD-L1）抑制剂，已在多种癌症中显示出显著的临床益处，并已迅速应用于治疗多种癌症，如黑色素瘤、非小细胞肺癌和头颈癌。与此同时，免疫相关不良事件（irAEs）的发生率一直在上升。在此病例中，我们报告一名45岁的转移性鼻咽癌男性患者，在接受属于抗PD-1药物的帕博利珠单抗治疗后第4天出现肺纤维化和心肌炎。尽管未能进行心内膜心肌活检（EMB），但与帕博利珠单抗治疗的强烈时间关联以及心电图、超声心动图和心血管磁共振（CMR）的特定变化表明，心肌损伤和水肿与帕博利珠单抗诱导的心肌炎有关。经过糖皮质激素治疗，症状和心肌病变几乎消失，患者同意在类固醇治疗的同时逐渐减少化疗剂量。
