Li Jiamo, Jiang Jianing, Lv Jinyan, Zhang Ru, Chen Wenting, Li Shiyi, Jin Qianchen, Wang Gang
Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China.
The Key Laboratory of Biomarker, High-Throughput Screening and Target Translation of Breast and Gastrointestinal Cancer, Dalian, Liaoning Province, People's Republic of China.
Onco Targets Ther. 2021 Nov 3;14:5227-5236. doi: 10.2147/OTT.S337331. eCollection 2021.
Anti-γ-aminobutyric acid type β receptor (anti-GABAR) antibody-associated encephalitis is a type of autoimmune encephalitis. According to current literature, its pathogenesis is reported to be closely related to tumor factors. However, diagnosis can be difficult because of the rarity of cases, limited clinical understanding, and a lack of specificity in clinical manifestation and imaging presentation. Clinical trials have demonstrated that immunotherapy can prolong the survival of patients with small cell lung cancer; however, in some cases, immunotherapy may induce anti-GABAR antibody-associated encephalitis. Patients who develop this encephalitis during immunotherapy often delay treatment because the cause is not clearly identified. In this study, we report a case of a 61-year-old man with a confirmed diagnosis of small cell lung cancer who had acute onset of cognitive impairment and seizures after two cycles of durvalumab (AstraZeneca UK Limited) combination chemotherapy. This reaction was initially considered as an immune-related adverse event (irAE) caused by durvalumab treatment, and the patient was eventually considered to have a paraneoplastic neurological disorder caused by the primary tumor. This report raises awareness of the symptoms of cognitive impairment and seizures in patients with small cell lung cancer, and the possible adverse events associated with immunotherapy. This case also highlights the importance of detecting anti-GABAR antibodies in patients with small cell lung cancer.
抗γ-氨基丁酸β型受体（抗GABAR）抗体相关脑炎是一种自身免疫性脑炎。根据目前的文献报道，其发病机制与肿瘤因素密切相关。然而，由于病例罕见、临床认识有限以及临床表现和影像学表现缺乏特异性，诊断可能较为困难。临床试验表明，免疫疗法可延长小细胞肺癌患者的生存期；然而，在某些情况下，免疫疗法可能诱发抗GABAR抗体相关脑炎。在免疫治疗期间发生这种脑炎的患者往往会延迟治疗，因为病因不明。在本研究中，我们报告了一例61岁确诊为小细胞肺癌的男性患者，在接受两个周期的度伐利尤单抗（阿斯利康英国有限公司）联合化疗后，急性出现认知障碍和癫痫发作。这种反应最初被认为是度伐利尤单抗治疗引起的免疫相关不良事件（irAE），该患者最终被认为患有由原发性肿瘤引起的副肿瘤性神经系统疾病。本报告提高了对小细胞肺癌患者认知障碍和癫痫发作症状以及与免疫治疗相关的可能不良事件的认识。该病例还强调了在小细胞肺癌患者中检测抗GABAR抗体的重要性。
