抗程序性死亡蛋白1（PD-1）抗体治疗肝细胞癌后发生的癌症相关性视网膜病变——1例中国患者的病例报告
Cancer-associated retinopathy after anti-programmed death 1 (PD-1) antibody for treating hepatocellular carcinoma--a case report of a Chinese patient.
作者信息
Chen Qian, Feng Chaoyi, Sun Chuanbin, Wang Wenji, Wang Min, Chen Ling, Sun Xinghuai, Tian Guohong
机构信息
Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.
Eye Center, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China.
出版信息
Am J Ophthalmol Case Rep. 2022 Jan 29;25:101370. doi: 10.1016/j.ajoc.2022.101370. eCollection 2022 Mar.
PURPOSE
Programmed death-1 (PD-1) receptor antibody immune therapy has been widely used for treating solid tumors, and cancer-associated retinopathy after the anti-PD1 treatment have not been reported yet. We report a Chinese patient presenting with acute constriction of visual fields after nivolumab treatment for hepatocellular carcinoma. The diagnosis of cancer-associated retinopathy was confirmed with optical coherence tomography, electroretinography, and positive results for recoverin paraneoplastic antibodies.
OBSERVATIONS
A 57-year-old Chinese man complained of acute visual fields constriction in both eyes for 20 days. He was diagnosed with hepatocellular carcinoma 5 months earlier and treated with chemotherapy for 4 months. He was administered 100 mg of nivolumab as an immune checkpoint inhibitor treatment once every 2 weeks. After 2 cycles of nivolumab, he presented with acute visual problems and was referred to a neuro-ophthalmologist. Brain magnetic resonance imaging excluded optic nerve infiltration and brain metastasis. Optical coherence tomography revealed binocular diffuse loss of outer retinal structures like the circumferential fovea of the macula, and full-field electroretinography showed an almost extinguished response. A serum anti-paraneoplastic antibody panel was positive for anti-recoverin antibodies. He was diagnosed with cancer-associated retinopathy. He was treated with systemic steroids, followed by tryptophan immunoadsorption for 3 cycles. His visual field had slightly improved at a 2-year follow-up.
CONCLUSIONS AND IMPORTANCE
Although paraneoplastic retinopathy could be diagnosed in tumor patients, acute-onset vision disturbance after anti-PD-1 treatment might be related to complications of the immune checkpoint inhibitor therapy. Cancer-associated retinopathy, as well as uveitis and optic neuropathy, might arise after anti-PD-1 therapy.
目的
程序性死亡蛋白1（PD-1）受体抗体免疫疗法已广泛用于实体瘤治疗，抗PD-1治疗后发生癌症相关性视网膜病变的情况尚未见报道。我们报告1例中国患者，在接受纳武单抗治疗肝细胞癌后出现急性视野缩小。通过光学相干断层扫描、视网膜电图检查以及 recoverin 副肿瘤抗体检测呈阳性确诊为癌症相关性视网膜病变。
观察结果
1例57岁中国男性患者，主诉双眼急性视野缩小20天。5个月前被诊断为肝细胞癌，接受了4个月化疗。每2周给予100 mg纳武单抗作为免疫检查点抑制剂治疗。纳武单抗治疗2个周期后，患者出现急性视力问题，并转诊至神经眼科医生处。脑部磁共振成像排除了视神经浸润和脑转移。光学相干断层扫描显示双眼黄斑中心凹等外周视网膜结构弥漫性缺失，全视野视网膜电图显示几乎无反应。血清抗副肿瘤抗体检测显示抗 recoverin 抗体呈阳性。患者被诊断为癌症相关性视网膜病变。给予全身类固醇治疗，随后进行3个周期的色氨酸免疫吸附治疗。随访2年时其视野略有改善。
结论及意义
尽管肿瘤患者可诊断为副肿瘤性视网膜病变，但抗PD-1治疗后急性发作的视力障碍可能与免疫检查点抑制剂治疗的并发症有关。抗PD-1治疗后可能会出现癌症相关性视网膜病变以及葡萄膜炎和视神经病变。
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