Do Tuong Vi C, Gudipati Mythili Kanthi, Ganti Subramanya Shyam, Depa Jayaramakrishna, Sajnani Kamlesh
Internal Medicine, West Anaheim Medical Center, Anaheim, USA.
Internal Medicine, Harlan ARH Hospital, Harlan, USA.
Cureus. 2021 Nov 18;13(11):e19726. doi: 10.7759/cureus.19726. eCollection 2021 Nov.
Immunotherapy is on the rise as a treatment option for advanced melanoma, non-small cell lung carcinoma, renal cell carcinoma, and melanoma among others. It consists of two main classes being cytotoxic T lymphocyte antigen 4 (CTLA 4) inhibitors and programmed cell death 1 (PD 1) inhibitors. We report a case series of four patients who were started on either pembrolizumab or nivolumab for the treatment of melanoma or lung cancer. While on immunotherapy, they developed various side effects related to the immunotherapy including pneumonitis, transaminitis, thyroiditis, nephritis, and hypophysitis. To treat this complication, immunotherapy must be discontinued or held with immunosuppressant initiation as treatment. Most often the immunosuppressant of choice is steroids. After symptoms improve, patients can decide along with the clinician on restarting or completely stopping immunotherapy. Within our case series, three of four patients had resolutions of their symptoms with steroid treatment with one who was lost to follow up. Of the three patients who were being followed up, one had a relapse of side effects after resuming immunotherapy and decided against further treatment with immunotherapy. Another patient is doing well resuming immunotherapy on a daily dose of steroids. The last patient decided to not continue with immunotherapy after experiencing a flare of his symptoms when he was being treated since he missed a few doses of steroids. Further research is needed about the risk of flares of complications when resuming immunotherapy alone or with immunotherapy and steroid treatment.
免疫疗法作为晚期黑色素瘤、非小细胞肺癌、肾细胞癌等疾病的一种治疗选择正在兴起。它主要包括两大类，即细胞毒性T淋巴细胞抗原4（CTLA 4）抑制剂和程序性细胞死亡1（PD 1）抑制剂。我们报告了一组4例患者的病例系列，这些患者开始使用派姆单抗或纳武单抗治疗黑色素瘤或肺癌。在接受免疫治疗期间，他们出现了各种与免疫治疗相关的副作用，包括肺炎、转氨酶升高、甲状腺炎、肾炎和垂体炎。为了治疗这种并发症，必须停用免疫治疗或在开始使用免疫抑制剂治疗时暂停。最常选用的免疫抑制剂是类固醇。症状改善后，患者可与临床医生共同决定是否重新开始或完全停止免疫治疗。在我们的病例系列中，4例患者中有3例通过类固醇治疗症状得到缓解，其中1例失访。在接受随访的3例患者中，1例在恢复免疫治疗后副作用复发，决定不再接受免疫治疗。另1例患者在每日服用类固醇的情况下恢复免疫治疗，情况良好。最后1例患者在接受治疗时因漏服了几剂类固醇而症状加重，决定不再继续接受免疫治疗。关于单独恢复免疫治疗或联合免疫治疗和类固醇治疗时并发症复发的风险，还需要进一步研究。
