Gambichler T, Seifert C, Lehmann M, Lukas C, Scheel C, Susok L
Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany.
Department of Throat, Nose & Ear, Ruhr-University Bochum, Bochum, Germany.
Immunotherapy. 2020 May;12(7):439-444. doi: 10.2217/imt-2019-0206. Epub 2020 Apr 19.
Vogt-Koyanagi-Harada disease (VKHD)-like symptoms have previously been reported in 11 melanoma patients treated with immune checkpoint inhibitors. We report a female patient with multilocular metastatic melanoma who was treated with nivolumab. Following the first nivolumab dose, she experienced bilateral blurry vision, hearing loss, vertigo and ataxia. Ocular ultrasound was consistent with the diagnosis of uveitis. Audiography revealed severe bilateral sensorineural hearing loss. A high-dose corticosteroid regimen was initiated under which the patient developed generalized vitiligo. Abdominal and thoracic CT scans showed an almost complete response to nivolumab therapy. This patient fulfilled all criteria of VKHD which is characterized pathogenetically by an antimelanocytic autoimmune process. The present case showed an impressive response to antimelanoma immunotherapy. Based on these data, the occurrence of VKHD in melanoma patients appears to be a strong indicator for immune checkpoint inhibitor efficacy.
此前有报道称，11例接受免疫检查点抑制剂治疗的黑色素瘤患者出现了类伏格特-小柳-原田病（VKHD）症状。我们报告了一名接受纳武单抗治疗的多房性转移性黑色素瘤女性患者。在首次使用纳武单抗后，她出现了双侧视力模糊、听力丧失、眩晕和共济失调。眼部超声检查结果与葡萄膜炎的诊断相符。听力图显示双侧严重感音神经性听力损失。开始采用高剂量皮质类固醇疗法，在此期间患者出现了全身性白癜风。腹部和胸部CT扫描显示对纳武单抗治疗几乎完全缓解。该患者符合VKHD的所有标准，其发病机制以抗黑素细胞自身免疫过程为特征。本病例显示出对抗黑色素瘤免疫疗法的显著反应。基于这些数据，黑色素瘤患者中VKHD的出现似乎是免疫检查点抑制剂疗效的有力指标。
