Gao Yining, Pan Jie, Shen Dingding, Peng Lisheng, Mao Zhifeng, Wang Chunxia, Meng Huanyu, Zhou Qinming, Chen Sheng
Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China.
Department of Neurology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314001, China.
Brain Sci. 2022 Jun 13;12(6):773. doi: 10.3390/brainsci12060773.
Immune checkpoint inhibitors (ICIs) are being used in patients with various advanced malignancies, and patient outcomes have improved considerably. Although ICIs can effectively treat tumors, 30-60% of patients experience immune-related adverse events (irAEs). Autoimmune encephalitis (AE) is a rare irAE that has become a novel topic in neuroimmunology and has received increasing attention in recent years. Herein, we report a rare case of GAD65-antibody-associated AE after metastatic small cell lung cancer treatment with pembrolizumab. The patient received IVIg therapy for AE and continuous pembrolizumab therapy without suspension of tumor treatment. At 1 year follow-up, both the patient's AE symptoms and tumors were stable. We consider that the treatment of ICI-associated AE should be more individualized with prudent decision-making and should balance the tumor progression and AE treatment. In addition, we have also comprehensively reviewed the literature of ICI-associated AE, and summarized the clinical features, treatment, and prognosis of AE caused by ICI, thus broadening our understanding of the neurological complications caused by ICI.
免疫检查点抑制剂（ICIs）正应用于各种晚期恶性肿瘤患者，患者的预后有了显著改善。尽管ICIs能有效治疗肿瘤，但30%-60%的患者会出现免疫相关不良事件（irAEs）。自身免疫性脑炎（AE）是一种罕见的irAE，已成为神经免疫学中的一个新课题，近年来受到越来越多的关注。在此，我们报告1例在使用派姆单抗治疗转移性小细胞肺癌后发生的罕见的与GAD65抗体相关的AE。该患者接受了AE的静脉注射免疫球蛋白（IVIg）治疗，并继续使用派姆单抗治疗，未中断肿瘤治疗。在1年的随访中，患者的AE症状和肿瘤均稳定。我们认为，ICI相关AE的治疗应更加个体化，谨慎决策，并且应平衡肿瘤进展和AE治疗。此外我们还全面回顾了ICI相关AE的文献，总结了ICI所致AE的临床特征、治疗及预后，从而拓宽了我们对ICI所致神经并发症的认识。
