Kubota Tetsushi, Choda Yasuhiro, Ishida Michihiro, Yano Takuya, Sato Daisuke, Yoshimitsu Masanori, Nakano Kanyu, Harano Masao, Matsukawa Hiroyoshi, Idani Hitoshi, Shiozaki Shigehiro, Okajima Masazumi
Dept. of Surgery, Hiroshima City Hiroshima Citizens Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):1860-1862.
The clinical efficacy of nivolumab has been shown as a third-line treatment for advanced gastric cancer; however, nivolumab sometimes causes immune-related adverse events(irAEs). We retrospectively examined the clinical features and influence on treatment in cases of irAEs after nivolumab treatment.
We retrospectively examined 43 patients who received nivolumab treatment at our institution between October 2017 and December 2019.
The incidence of irAEs was 23.2%(10/43), and Grade 3 or higher irAEs included interstitial pneumonia, hypoadrenalism, Stevens- Johnson syndrome(SJS), and type 1 diabetes. Three patients showed long-term disease control after irAE onset. Meanwhile, SJS prevented patients from continuing treatment for gastric cancer.
Nivolumab is effective in some patients with gastric cancer, while irAEs made subsequent treatment difficult. Trifluridine/tipiracil or irinotecan are also known to be effective as therapeutic drugs after third-line treatment for gastric cancer in addition to nivolumab; therefore, the choice of the third-line drug and management of irAEs owing to individual cases are considered desirable.
Long-term efficacy is expected with nivolumab, but it may be necessary to recognize that the onset of serious irAEs might make subsequent treatment difficult.
纳武利尤单抗作为晚期胃癌的三线治疗药物，其临床疗效已得到证实；然而，纳武利尤单抗有时会引起免疫相关不良事件（irAEs）。我们回顾性研究了纳武利尤单抗治疗后发生irAEs的病例的临床特征及其对治疗的影响。
我们回顾性研究了2017年10月至2019年12月期间在我院接受纳武利尤单抗治疗的43例患者。
irAEs的发生率为23.2%（10/43），3级及以上irAEs包括间质性肺炎、肾上腺功能减退、史蒂文斯-约翰逊综合征（SJS）和1型糖尿病。3例患者在irAE发作后实现了长期疾病控制。同时，SJS导致患者无法继续进行胃癌治疗。
纳武利尤单抗对部分胃癌患者有效，但irAEs会使后续治疗变得困难。除纳武利尤单抗外，曲氟尿苷/替匹嘧啶或伊立替康作为胃癌三线治疗后的治疗药物也被认为是有效的；因此，考虑根据个体情况选择三线药物并管理irAEs是可取的。
纳武利尤单抗有望实现长期疗效，但可能有必要认识到严重irAEs的发作可能会使后续治疗变得困难。
