Khan Alisha, Riaz Sana, Carhart Robert
Department of Medicine, SUNY Upstate Medical University, USA.
Department of Cardiology, SUNY Upstate Medical University, USA.
Case Rep Cardiol. 2020 Jan 28;2020:8428210. doi: 10.1155/2020/8428210. eCollection 2020.
Pembrolizumab is a monoclonal antibody directed towards programmed cell death protein 1 (PD-1) and is an antineoplastic drug which has a growing variety of oncologic uses. Pembrolizumab is commonly associated with immune-related adverse events (IRAEs) but is infrequently noted to cause cardiotoxicities such as myocarditis, arrhythmias, and heart failure. The following case report illustrates the clinical course of a 67-year-old female patient with stage IV non-small-cell lung cancer who developed Mobitz type 2 second-degree atrioventricular block three weeks after receiving her first infusion of pembrolizumab. Within a few hours of presentation, she progressed to symptomatic complete heart block requiring emergent placement of a temporary transvenous pacemaker. The article further discusses proposed mechanisms to explain IRAEs and management of IRAEs. We conclude by recommending a higher degree of caution and awareness among all physicians when treating patients on immunotherapy and a multidisciplinary approach when considering resumption of immune checkpoint inhibitor therapy.
帕博利珠单抗是一种针对程序性细胞死亡蛋白1（PD-1）的单克隆抗体，是一种抗肿瘤药物，其肿瘤学用途日益广泛。帕博利珠单抗通常与免疫相关不良事件（IRAEs）相关，但很少引起心脏毒性，如心肌炎、心律失常和心力衰竭。以下病例报告描述了一名67岁IV期非小细胞肺癌女性患者在首次输注帕博利珠单抗三周后发生莫氏II型二度房室传导阻滞的临床过程。在就诊后的几个小时内，她进展为有症状的完全性心脏传导阻滞，需要紧急植入临时经静脉起搏器。本文进一步讨论了解释IRAEs的可能机制以及IRAEs的管理。我们建议所有医生在治疗接受免疫治疗的患者时要更加谨慎并提高认识，在考虑恢复免疫检查点抑制剂治疗时采用多学科方法。
