Taillefer Vincent-Thierry, Pigeon Marjorie, Chen Michelle, Larochelle Catherine, Florescu Marie, Bélanger Karl, Adam Jean-Philippe
Faculty of Pharmacy, Université de Montréal, Montréal, Canada.
Department of Pharmacy, Centre hospitalier de l'Universite de Montreal, Montreal, Canada.
J Oncol Pharm Pract. 2020 Sep;26(6):1538-1543. doi: 10.1177/1078155220904147. Epub 2020 Feb 17.
Nivolumab is a programmed death 1 (PD-1) inhibitor approved by the Food and Drug Administration (FDA) for the treatment of eight different cancers including metastatic melanoma. Immune checkpoint blockade may lead to a range of neurologic immune-related adverse events (irAEs) with severity varying from mild to life-threatening, including encephalitis.
We describe a case of a 68-year-old man who developed alteration in mental status, physical weakness and fatigue after nine cycles of nivolumab 3 mg/kg every two weeks. These symptoms were compatible with a clinical diagnosis of autoimmune limbic encephalitis, although no specific antibodies were detected and the initial MRI was normal.
The patient received intravenous methylprednisolone 1 g daily for 5 days, which was then converted to a maintenance dose of oral prednisone. The patient made a full clinical recovery but relapsed clinically upon steroid tapering, while hypersignal in the left mesial temporal suggestive of limbic encephalitis was observed on repeated MRI.
Because of the prevailing usage of nivolumab in many cancer protocols, this case highlights the importance of rapidly recognising neurological impairment in patients treated with nivolumab and of initiating very high doses of corticosteroids.
纳武单抗是一种程序性死亡受体1（PD-1）抑制剂，已获美国食品药品监督管理局（FDA）批准用于治疗包括转移性黑色素瘤在内的八种不同癌症。免疫检查点阻断可能导致一系列神经免疫相关不良事件（irAEs），严重程度从轻度到危及生命不等，包括脑炎。
我们描述了一例68岁男性患者，每两周接受3mg/kg纳武单抗治疗九个周期后出现精神状态改变、身体虚弱和疲劳。这些症状符合自身免疫性边缘叶脑炎的临床诊断，尽管未检测到特异性抗体且初始MRI检查正常。
患者接受了为期5天的每日1g静脉注射甲泼尼龙治疗，随后转换为口服泼尼松维持剂量。患者临床完全康复，但在减停激素时临床复发，重复MRI检查发现左侧颞叶内侧出现提示边缘叶脑炎的高信号。
鉴于纳武单抗在许多癌症治疗方案中的广泛应用，该病例突出了快速识别接受纳武单抗治疗患者的神经功能损害以及启动大剂量皮质类固醇治疗的重要性。
