Galli Giulia, Proto Claudia, Cossa Mara, Valeri Barbara, Sdao Silvana, Signorelli Diego, Imbimbo Martina, de Braud Filippo, Garassino Marina Chiara, Lo Russo Giuseppe
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Tumori. 2019 Dec;105(6):NP57-NP62. doi: 10.1177/0300891619872546. Epub 2019 Aug 28.
Immunotherapy has shown efficacy in the treatment of different malignancies. Nivolumab, an immune checkpoint inhibitor directed against programmed death-1, has been approved for non-small cell lung cancer (NSCLC) in pretreated patients. Although it is generally well-tolerated, immunotherapy may be complicated by a wide range of immune-mediated adverse events. We describe the case of an uncommon skin toxicity arising as alopecia universalis induced by nivolumab in a patient with NSCLC.
A 58-year-old man received nivolumab for metastatic NSCLC after progression to 3 lines of chemotherapy. The treatment was prescribed in June 2016, and induced a rapid and significant disease response. Nivolumab was well-tolerated until May 2017, when partial alopecia at hair and eyelashes appeared. In the next months, alopecia became complete and extended to the whole body surface. The dermatologic picture was compatible with alopecia areata. A topical steroid therapy was attempted, without benefit. The patient refused systemic treatments and is still undergoing nivolumab without new toxicities and with persistent disease response.
This case suggests that alopecia areata may be a rare immune-related adverse event of immune checkpoint agents. Its late onset in our patient is uncommon and unexpected, underlining that the risk of nivolumab-induced toxicity is not limited to the beginning of treatment. Despite its rarity, alopecia areata should be considered in the range of adverse events potentially induced by immune checkpoint inhibitors even in the long term. Potential association between toxicity and efficacy of immunotherapy in NSCLC warrants further investigation.
免疫疗法已在不同恶性肿瘤的治疗中显示出疗效。纳武单抗是一种针对程序性死亡-1的免疫检查点抑制剂，已被批准用于经治的非小细胞肺癌（NSCLC）患者。尽管其总体耐受性良好，但免疫疗法可能会并发多种免疫介导的不良事件。我们描述了一例非小细胞肺癌患者因纳武单抗诱发的罕见皮肤毒性，表现为普秃。
一名58岁男性在接受3线化疗进展后接受纳武单抗治疗转移性非小细胞肺癌。该治疗于2016年6月开始，诱导了快速且显著的疾病缓解。纳武单抗耐受性良好，直到2017年5月，头发和睫毛出现部分脱发。在接下来的几个月里，脱发变得完全并扩展到全身皮肤。皮肤科表现与斑秃相符。尝试了局部类固醇治疗，但无效。患者拒绝全身治疗，仍在接受纳武单抗治疗，无新的毒性反应且疾病持续缓解。
该病例表明斑秃可能是免疫检查点药物罕见的免疫相关不良事件。其在我们患者中的迟发性罕见且出乎意料，强调纳武单抗诱导毒性的风险不限于治疗开始时。尽管罕见，但即使在长期，斑秃也应被视为免疫检查点抑制剂可能诱发的不良事件之一。非小细胞肺癌免疫疗法毒性与疗效之间的潜在关联值得进一步研究。
