Department of Surgery,The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
Iran J Immunol. 2020 Jun;17(2):167-171. doi: 10.22034/iji.2020.85507.1717.
Anti-programmed cell death 1(anti-PD-1) antibodies are immune checkpoint inhibitors (ICIs) used as a treatment option for a number of cancers to expand lifespan. However, the toxicity caused by ICIs is often unpredictable and can be occasionally life-threatening.
To evaluate the immune-related adverse events (irAEs) induced by Camrelizumab, an anti-PD-1 antibody in a patient with gastric cancer.
The patient was a 32-year-old man who was diagnosed with stage IIIA gastric adenocarcinoma (cT4aN1M0) in pre-operative evaluation. However, pancreatic invasion and peritoneal metastasis were found during surgery. He received a three-week cycle of 200 mg Camrelizumab combined with systemic chemotherapy. After the fifth administration of Camrelizumab, the patient displayed irAE mimicking Behcet's disease with oral and penile ulcers, skin and abdominal incision lesions. Camrelizumab was permanently discontinued, but systemic chemotherapy was continued. The symptoms were improved with discontinuation of Camrelizumab and administration of glucocorticoid and immunosuppressive agents for 8 weeks, but suspicious liver metastases occurred and carbohydrate antigen 19-9 showed an increasing trend in the meantime. Given the significant improvement in the patient's symptoms after discontinuation of Camrelizumab and administration of corticosteroids and immunosuppressants, we assumed that these treatments may play a role in the rehabilitation of patients.
Severe irAEs occur at a low frequency when anti-PD-1 antibodies are used as monotherapy. Whether anti-PD-1 antibodies combined with systemic chemotherapy increase the incidence of irAEs is not certain.
抗程序性细胞死亡蛋白 1（anti-PD-1）抗体是免疫检查点抑制剂（ICIs），用于治疗多种癌症以延长患者的寿命。然而，ICI 引起的毒性通常是不可预测的，有时可能危及生命。
评估抗 PD-1 抗体卡瑞利珠单抗（Camrelizumab）在胃癌患者中引起的免疫相关不良事件（irAEs）。
患者为 32 岁男性，术前评估诊断为 IIIA 期胃腺癌（cT4aN1M0）。但在手术中发现胰腺侵犯和腹膜转移。他接受了 200mg Camrelizumab 联合全身化疗的三周周期治疗。在 Camrelizumab 第五次给药后，患者出现类似贝赫切特病的 irAE，表现为口腔和阴茎溃疡、皮肤和腹部切口损伤。Camrelizumab 被永久停用，但继续进行全身化疗。停用 Camrelizumab 并给予糖皮质激素和免疫抑制剂治疗 8 周后，症状得到改善，但可疑肝转移发生，同时碳水化合物抗原 19-9 呈上升趋势。鉴于 Camrelizumab 和皮质类固醇及免疫抑制剂停药后患者症状显著改善，我们假设这些治疗可能在患者康复中发挥作用。
抗 PD-1 抗体单药治疗时，严重 irAEs 发生率较低。抗 PD-1 抗体联合全身化疗是否会增加 irAEs 的发生率尚不确定。
