Klee Gina, Kisch Tobias, Kümpers Christiane, Perner Sven, Schinke Susanne, Zillikens Detlef, Langan Ewan A, Terheyden Patrick
Department of Dermatology.
Department of Plastic Surgery, University of Luebeck.
Rheumatol Adv Pract. 2021 Sep 28;5(3):rkab037. doi: 10.1093/rap/rkab037. eCollection 2021.
Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine skin cancer, which typically affects elderly and immunocompromised and/or immunosuppressed patients. The checkpoint inhibitor avelumab, a mAb targeting the anti-programmed cell death ligand 1 (anti-PD-L1), has revolutionized the treatment of metastatic MCC, achieving dramatic improvements in disease control and overall survival. However, checkpoint inhibitors are associated with the development of immune-related adverse events, such as exacerbation of pre-existing RA. Although most immune-related adverse events can be managed successfully with CSs, their frequent and/or long-term use runs the risk of undermining the efficacy of immune checkpoint inhibition.
We report two cases of MCC, in which immunosuppressive therapy for the management of RA was administered.
Immunosuppression for (i) pre-existing and (ii) immune checkpoint inhibitor-exacerbated RA was associated with progression of metastatic MCC.
Any decision to initiate immunosuppressive treatment for RA in patients receiving immune checkpoint inhibitor therapy should include careful consideration of the risk of potentially fatal cancer progression and be taken after consultation with the patient's oncologist and rheumatologist. When the immunosuppressive treatment is required, it should be administered for as short a time as possible and under strict clinical and radiological surveillance.
默克尔细胞癌（MCC）是一种罕见的、侵袭性很强的神经内分泌皮肤癌，通常影响老年人以及免疫功能低下和/或免疫抑制的患者。检查点抑制剂阿维鲁单抗是一种靶向抗程序性细胞死亡配体1（抗PD-L1）的单克隆抗体，它彻底改变了转移性MCC的治疗方式，在疾病控制和总生存期方面取得了显著改善。然而，检查点抑制剂与免疫相关不良事件的发生有关，比如使已有的类风湿关节炎（RA）病情加重。尽管大多数免疫相关不良事件可以通过使用糖皮质激素（CSs）成功处理，但频繁和/或长期使用糖皮质激素有削弱免疫检查点抑制疗效的风险。
我们报告了两例MCC病例，其中对RA进行了免疫抑制治疗。
对（i）已有的和（ii）免疫检查点抑制剂加重的RA进行免疫抑制与转移性MCC的进展相关。
在接受免疫检查点抑制剂治疗的患者中，任何启动针对RA的免疫抑制治疗的决定都应仔细考虑潜在致命性癌症进展的风险，并且要在与患者的肿瘤内科医生和风湿病学家协商后做出。当需要进行免疫抑制治疗时，应尽可能缩短治疗时间，并在严格的临床和影像学监测下进行。
