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病例报告:免疫检查点抑制剂诱导的严重结肠炎患者抗TNF治疗失败

Case Report: Anti-TNF Treatment Failure in a Patient With Immune Checkpoint Inhibitor-Induced Severe Colitis.

作者信息

Fang Leilei, Liu Changqin, Sun Xiaomin, Liu Zhanju

机构信息

Center for IBD Research, The Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

出版信息

Front Oncol. 2022 Jun 23;12:925964. doi: 10.3389/fonc.2022.925964. eCollection 2022.

Abstract

Immune checkpoint inhibitor (ICI)-induced colitis is one of the known complications of therapies targeting cytotoxic programmed cell death protein 1 (PD-1), cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), and programmed cell death ligand 1 (PD-L1). ICI-associated colitis is routinely treated with immunosuppressive therapy, including corticosteroids and/or agents targeting tumor necrosis factor-α (TNF-α). In this report, a 69-year-old male patient developed severe ICI-induced colitis 2 weeks after anti-PD-L1 mAb (i.e., durvalumab) treatment; unexpectedly failed to respond to systemic corticosteroid, anti-TNF, and anti-integrin agents; and unfortunately died in 1 month. This case reminds clinical physicians to be on the alert for early-onset acute ICI-induced colitis and emphasizes that urgent optimized rescue measures are required for patients with severe ICI-induced colitis.

摘要

免疫检查点抑制剂(ICI)诱导的结肠炎是靶向细胞毒性程序性细胞死亡蛋白1(PD-1)、细胞毒性T淋巴细胞相关抗原4(CTLA-4)和程序性细胞死亡配体1(PD-L1)治疗的已知并发症之一。ICI相关结肠炎通常采用免疫抑制治疗,包括皮质类固醇和/或靶向肿瘤坏死因子-α(TNF-α)的药物。在本报告中,一名69岁男性患者在接受抗PD-L1单克隆抗体(即度伐鲁单抗)治疗2周后发生严重的ICI诱导结肠炎;出乎意料的是,对全身皮质类固醇、抗TNF和抗整合素药物均无反应;不幸的是,患者在1个月内死亡。该病例提醒临床医生警惕早期发作的急性ICI诱导结肠炎,并强调对于严重ICI诱导结肠炎患者需要采取紧急优化的抢救措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6edb/9259980/054c540d31ba/fonc-12-925964-g001.jpg

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本文引用的文献

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