Guidi Alessandro, Violati Martina, Blasi Miriam, Ferrari Elettra, Luciani Andrea, Codecà Carla, Ferrari Daris
Department of Medical Oncology, San Paolo Hospital, Milan, Italy.
Tumori. 2020 Dec;106(6):NP23-NP28. doi: 10.1177/0300891620951262. Epub 2020 Aug 27.
Head and neck cancer represents a variety of tumors involving different organs in the cervical district, burdened by poor prognosis when diagnosed in an advanced stage. Immunotherapy with both anti-PD-1 nivolumab and pembrolizumab has the aim of increasing overall survival for patients with this malignancy. We report the first case of immune-related encephalitis caused by nivolumab in this setting of disease and present a brief review of the literature.
A 60-year-old woman had been treated with concomitant chemoradiotherapy for a locally advanced human papillomavirus-negative squamous cell carcinoma of the tonsil. After local recurrence, she was treated with platinum-based first-line chemotherapy, followed by nivolumab at further progression within 6 months. Nivolumab was administered for 19 weeks, then discontinued due to the occurrence of immune-related hypothyroidism and grade 2 diarrhea. A month after the onset of the endocrinopathy, the patient also developed steroid-responsive encephalitis, considered as a consequence of anti-PD-1 therapy. One year after discontinuation of immunotherapy, toxicities have resolved and the patient is maintaining a complete radiologic response.
Immunotherapy is a relatively new and promising therapy in the field of oncology. Its mechanism of action, which aims to stimulate the immune system against cancer cells, is not comparable to systemic and cytotoxic chemotherapy, which directly attacks and destroys malignant cells. Despite these differences, immunotherapy is not to be considered free from side effects, sometimes life-threatening.
头颈癌是指发生于颈部区域不同器官的多种肿瘤，晚期诊断时预后较差。抗程序性死亡蛋白1（PD-1）的纳武单抗和派姆单抗免疫疗法旨在提高此类恶性肿瘤患者的总生存期。我们报告了在这种疾病背景下由纳武单抗引起的首例免疫相关性脑炎病例，并对相关文献进行简要综述。
一名60岁女性因局部晚期人乳头瘤病毒阴性扁桃体鳞状细胞癌接受同步放化疗。局部复发后，她接受了铂类一线化疗，6个月内病情进一步进展后接受了纳武单抗治疗。纳武单抗使用了19周，随后因出现免疫相关性甲状腺功能减退和2级腹泻而停药。内分泌病发作1个月后，患者还出现了对类固醇有反应的脑炎，被认为是抗PD-1治疗的结果。免疫治疗停药1年后，毒性反应已消退，患者维持完全的影像学缓解。
免疫疗法是肿瘤学领域一种相对较新且有前景的治疗方法。其作用机制旨在刺激免疫系统对抗癌细胞，与直接攻击和破坏恶性细胞的全身细胞毒性化疗不同。尽管存在这些差异，但免疫疗法并非没有副作用，有时甚至会危及生命。
