Todo Maki, Kaneko Gou, Shirotake Suguru, Shimada Yuki, Nakano Shintaro, Okabe Takashi, Ishikawa Shiho, Oyama Masafumi, Nishimoto Koshiro
Department of Pharmacy Saitama Medical University International Medical Center Hidaka Saitama Japan.
Department of Uro-Oncology Saitama Medical University International Medical Center Hidaka Saitama Japan.
IJU Case Rep. 2019 Oct 30;3(1):17-20. doi: 10.1002/iju5.12128. eCollection 2020 Jan.
Pembrolizumab cause immune-related adverse events. We herein report a case of advanced bladder cancer, who treated with pembrolizumab and exhibited intriguing clinical course.
A 63-year-old man with bladder carcinoma was treated by radical cystectomy, however, the bladder carcinoma recurred and invaded to the rectum. He was treated by combination therapy using gemcitabine and cisplatin, which were not effective for the tumor. He subsequently underwent treatment with pembrolizumab. In several 30 days, he suffered from the symptoms of myasthenia gravis. Serum levels of creatine kinase, its isozyme creatine kinase-myocardial band, and troponin I were elevated. Electrocardiography showed a right bundle branch block. These findings suggested that he was myasthenia gravis with general myositis and presumable myocarditis. Oral prednisolone administration significantly attenuated these findings. The tumor drastically shrunk only by the single injection of pembrolizumab.
Early intervention with corticosteroid was effective for neuromuscular complications due to pembrolizumab.
帕博利珠单抗可引起免疫相关不良事件。我们在此报告一例晚期膀胱癌患者，其接受了帕博利珠单抗治疗并呈现出有趣的临床病程。
一名63岁的膀胱癌男性患者接受了根治性膀胱切除术，但膀胱癌复发并侵犯至直肠。他接受了吉西他滨和顺铂的联合治疗，但对肿瘤无效。随后他接受了帕博利珠单抗治疗。在几个30天内，他出现了重症肌无力症状。血清肌酸激酶、其同工酶肌酸激酶-心肌型以及肌钙蛋白I水平升高。心电图显示右束支传导阻滞。这些发现提示他患有重症肌无力合并全身性肌炎以及可能的心肌炎。口服泼尼松龙显著减轻了这些症状。仅单次注射帕博利珠单抗后肿瘤就大幅缩小。
早期使用皮质类固醇进行干预对帕博利珠单抗引起的神经肌肉并发症有效。
