Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Immunol. 2021 Apr 15;12:621858. doi: 10.3389/fimmu.2021.621858. eCollection 2021.
Immune checkpoint inhibitor therapy has become a promising option for the treatment of late-stage thymic epithelial tumors. In this manuscript, we presented a patient with metastatic thymoma administrated of anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab. Although the patient underwent a rapid and dramatic response to one dose of pembrolizumab, she suffered a storm of immune-therapy related toxicity events (irAEs), including liver and kidney dysfunction, hypothyroidism and myocarditis. We didn't observe >grade 3 irAEs, and proceed with pembrolizumab therapy after the function recovered. Although no guidelines recommend dose reduction of immunotherapy re-treating following initial irAEs, we optimize dose of pembrolizumab to minimize the irAEs induced by PD-1 antibody while maintaining clinical effectiveness. Excitingly, we observe remarkable tumor remission and mild toxicities of half dose of pembrolizumab in this case. In conclusion, the clinical utilization of immunotherapy is an encouraging therapeutic alternative for advanced thymomas. At the same time, patients have to be monitored very carefully, because of the risk to develop irAEs.
免疫检查点抑制剂治疗已成为晚期胸腺瘤治疗的一种有前途的选择。在本手稿中，我们报告了一例转移性胸腺癌患者接受抗程序性细胞死亡蛋白 1（PD-1）抗体派姆单抗治疗的情况。尽管该患者对派姆单抗的一剂治疗迅速且明显反应，但她出现了免疫治疗相关毒性事件（irAEs）的风暴，包括肝肾功能障碍、甲状腺功能减退和心肌炎。我们没有观察到> 3 级 irAEs，并在功能恢复后继续进行派姆单抗治疗。虽然没有指南建议在初始 irAEs 后重新开始免疫治疗时减少剂量，但我们优化了派姆单抗的剂量，以在保持临床疗效的同时最小化 PD-1 抗体引起的 irAEs。令人兴奋的是，在本例中，我们观察到半剂量派姆单抗的肿瘤显著缓解和轻微毒性。总之，免疫治疗的临床应用是晚期胸腺瘤治疗的一种令人鼓舞的治疗选择。同时，由于发生 irAEs 的风险，患者必须进行非常仔细的监测。
