University of South Alabama Mitchell Cancer Institute, Mobile, AL.
J Immunother. 2019 Oct;42(8):318-320. doi: 10.1097/CJI.0000000000000291.
By targeting receptors that serve to downregulate the cellular immune system, monoclonal antibodies such as ipilimumab and nivolumab have transformed the management of metastatic melanoma, and their use is referred to as immune checkpoint therapy (ICT). However, because the antitumoral activity of these agents is achieved through the reversal of mechanisms that naturally serve to temper the immune response, the potential for adverse reactions secondary to autoimmunity is of clinical significance. Neurological immune-related adverse events (irAEs) may occur consequent to ICT, and the development of autoimmune Bell's palsy is a specific, uncommon manifestation of the body's immune response against the seventh cranial nerve, resulting in acute paresis of facial muscles. We describe 2 cases of autoimmune Bell's palsy following the administration of combination ICT using ipilimumab and nivolumab in 2 patients with metastatic melanoma. The use of a steroid taper in addition to the cessation of combination immunotherapy resulted in resolution of symptoms for both patients. In the first case, the patient was subsequently started on nivolumab monotherapy but developed autoimmune polyneuropathy, and immunotherapy was discontinued indefinitely. In the second case, the initiation of nivolumab monotherapy following resolution of symptoms resulted in an inadequate antitumoral response. Subsequent transition to treatment with encorafenib/binimetinib initially provided a positive response but also required discontinuation secondary to irAEs. Both of these cases demonstrate the potential for autoimmune Bell's palsy as a consequence of combination ICT and provide evidence of successful treatment of this irAE through temporary discontinuation of immunotherapy and administration of steroids.
通过靶向下调细胞免疫系统的受体，单克隆抗体如伊匹单抗和纳武单抗已经改变了转移性黑色素瘤的治疗方法，其使用被称为免疫检查点治疗（ICT）。然而，由于这些药物的抗肿瘤活性是通过逆转自然调节免疫反应的机制来实现的，因此继发于自身免疫的不良反应的潜在风险具有临床意义。免疫相关的神经系统不良反应（irAEs）可能继发于 ICT，而自身免疫性贝尔氏面瘫的发生是机体针对第七颅神经的免疫反应的一种特定的、罕见的表现，导致面部肌肉急性瘫痪。我们描述了 2 例转移性黑色素瘤患者接受伊匹单抗和纳武单抗联合 ICT 治疗后发生自身免疫性贝尔氏面瘫的病例。在这 2 例患者中，除了停止联合免疫治疗外，还使用了类固醇减量，结果症状均得到缓解。在第一个病例中，患者随后开始接受纳武单抗单药治疗，但又发生了自身免疫性多发性神经病，免疫治疗被无限期停止。在第二个病例中，症状缓解后开始接受纳武单抗单药治疗，但抗肿瘤反应不足。随后改用恩考芬尼/比美替尼治疗，最初有积极反应，但也因 irAEs 而需要停药。这两个病例都表明自身免疫性贝尔氏面瘫可能是联合 ICT 的后果，并证明通过暂时停止免疫治疗和使用类固醇可以成功治疗这种 irAE。
