Department of Medicine, MSF/Doctors without Borders, Amman, Jordan.
Department of Medicine, Creighton University, Omaha, NE 68131, USA.
Immunotherapy. 2020 Jun;12(9):625-628. doi: 10.2217/imt-2020-0053. Epub 2020 May 18.
Immunotherapy has revolutionized the treatment of cancer, but this has not come without a cost. Although immune checkpoint inhibitors are less toxic than conventional chemotherapy, they are associated with more frequent autoimmune side effects. We report a case of a patient with metastatic renal cell carcinoma who was treated with nivolumab and subsequently developed treatment related hypothyroidism with consequent rhabdomyolysis. Treatment with thyroxine resulted in resolution of the symptoms. Because of normal thyroid function tests before initiating nivolumab therapy and the absence of any other causes of hypothyroidism, it was safe to extrapolate a causal relationship between nivolumab and hypothyroidism. To date, this is the first reported case of a programmed cell death-1 inhibitor causing hypothyroidism, severe enough to induce rhabdomyolysis. Patients on nivolumab and other PD-1 inhibitors should be monitored and screened regularly for immune-related adverse events.
免疫疗法彻底改变了癌症的治疗方法，但这并非没有代价。虽然免疫检查点抑制剂的毒性比传统化疗要低，但它们与更频繁的自身免疫副作用有关。我们报告了一例转移性肾细胞癌患者，该患者接受了纳武单抗治疗，随后出现了与治疗相关的甲状腺功能减退症，进而导致横纹肌溶解症。甲状腺素治疗后症状得到缓解。由于纳武单抗治疗前甲状腺功能检查正常，且无其他导致甲状腺功能减退症的原因，因此可以推断纳武单抗与甲状腺功能减退症之间存在因果关系。迄今为止，这是首例程序性死亡受体-1 抑制剂导致甲状腺功能减退症的报道，严重程度足以引发横纹肌溶解症。接受纳武单抗和其他 PD-1 抑制剂治疗的患者应定期监测和筛查免疫相关不良事件。
