Yu Qing, Wang Wen-Xia
Department of Periodontology, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan 250012, Shandong Province, China.
World J Clin Cases. 2020 Feb 6;8(3):624-629. doi: 10.12998/wjcc.v8.i3.624.
Oncologic immunotherapy is attracting attention as an effective strategy for cancer treatment. Currently, there are two kinds of inhibitors: Anti-PD-1 antibodies and anti-PD-L1 antibodies. These inhibitors have shown significant implications in improving the outcomes of certain cancer types in recent years. However, along with its effectiveness, adverse events cannot be ignored. As an anti-PD-1 antibody, camrelizumab (SHR-1210) has some side effects in tumor immunotherapy. The most common adverse event is reactive capillary hemangioma. While it is widely reported to occur in the skin, gingival reactive capillary hemangioma is rarely reported.
A 54-year-old man complained of gingival overgrowth on the anterior aspect of the maxilla and mandible for more than 6 mo. He had been placed on SHR-1210 for lung cancer for 7 mo. A gingival mass extending from canine to canine was noted on the lingual surfaces of the mandible. Gingival enlargement was noted in the front teeth. A clinical diagnosis of gingival reactive capillary hemangioma and chronic periodontitis was made. The treatment involved a complex local treatment (repeated local applications of an antibiotic paste, scaling and root planning, and surgery). The excised tissue was sent for histopathological examination, which confirmed the diagnosis of capillary hemangioma. After the operation, most of the gingival enlargement was reduced. At the 2-mo follow-up, it was noted that the gingival overgrowth was immediately reduced after the replacement of the anti-PD-1 agent with an anti-PD-L1 agent.
As the prescription for SHR-1210 has increased considerably in recent years, the occurrence of its possible side effects, including gingival reactive capillary hemangioma, has increased. It is recommended that regular oral examinations be performed before and during the treatment of tumors with SHR-1210.
肿瘤免疫疗法作为一种有效的癌症治疗策略正受到关注。目前，有两种抑制剂：抗程序性死亡蛋白1（PD-1）抗体和抗程序性死亡配体1（PD-L1）抗体。近年来，这些抑制剂在改善某些癌症类型的治疗结果方面显示出显著效果。然而，伴随着其有效性，不良事件也不容忽视。作为一种抗PD-1抗体，卡瑞利珠单抗（SHR-1210）在肿瘤免疫治疗中存在一些副作用。最常见的不良事件是反应性毛细血管瘤。虽然其在皮肤中广泛报道，但牙龈反应性毛细血管瘤鲜有报道。
一名54岁男性主诉上颌和下颌前部牙龈增生超过6个月。他因肺癌接受SHR-1210治疗7个月。在下颌舌侧表面发现一个从尖牙延伸至尖牙的牙龈肿物。前牙区可见牙龈肿大。临床诊断为牙龈反应性毛细血管瘤和慢性牙周炎。治疗包括复杂的局部治疗（反复局部应用抗生素糊剂、龈上洁治和根面平整以及手术）。切除的组织送去做组织病理学检查，结果证实为毛细血管瘤。手术后，大部分牙龈肿大减轻。在2个月的随访中，注意到在用抗PD-L1药物替代抗PD-1药物后，牙龈增生立即减轻。
近年来，随着SHR-1210处方量的大幅增加，其可能的副作用包括牙龈反应性毛细血管瘤的发生率也有所增加。建议在用SHR-1210治疗肿瘤之前和期间进行定期口腔检查。
