Abdominal Oncology Ward, West China Hospital, Sichuan University, Cancer Center, Chengdu, China.
Division of Radiotherapy, West China Hospital, Sichuan University, Cancer Center, Chengdu, China.
BMC Neurol. 2023 Mar 4;23(1):96. doi: 10.1186/s12883-023-03140-7.
Immune checkpoint inhibitor (ICI) combined with chemotherapy has exhibited promising results in small sample studies of pancreatic cancer patients. The efficacy of toripalimab, a programmed cell death protein 1 (PD-1) monoclonal antibody has been explored in the previous studies and it was established that immune-related adverse events (irAEs) associated with administration of this drug deserve proper attention and adequate management.
A 43-year-old female patient with advanced pancreatic ductal adenocarcinoma (PDAC) was treated with toripalimab in combination with gemcitabine and nab-paclitaxel (T-GA) as the first-line treatment. She developed immune-related encephalopathy with stuttering as the main clinical symptom and Magnetic resonance imaging (MRI) showed multiple cerebral white matter demyelination changes, concomitant with asymptomatic cardiac enzyme elevation and hypothyroidism. The symptoms resolved after the discontinuation of toripalimab and corticosteroid treatment.
Stuttering might be an early sign of neurotoxicity which can be easily neglected during the treatment. These findings provide guidance for the identification of these rare and occult neurological irAEs (n-irAEs) in the clinical practice.
免疫检查点抑制剂（ICI）联合化疗在小样本胰腺癌患者研究中显示出有前景的结果。程序性细胞死亡蛋白 1（PD-1）单克隆抗体 toripalimab 的疗效已在先前的研究中得到探讨，并且已经确定与该药物给药相关的免疫相关不良事件（irAEs）值得引起适当关注和充分管理。
一名 43 岁女性晚期胰腺导管腺癌（PDAC）患者接受 toripalimab 联合吉西他滨和 nab-紫杉醇（T-GA）作为一线治疗。她出现以口吃为主要临床症状的免疫相关性脑病，磁共振成像（MRI）显示多发性脑白质脱髓鞘改变，同时伴有无症状的心肌酶升高和甲状腺功能减退。停用 toripalimab 和皮质类固醇治疗后症状缓解。
口吃可能是神经毒性的早期迹象，在治疗过程中很容易被忽视。这些发现为临床实践中识别这些罕见和隐匿性神经免疫相关不良事件（n-irAEs）提供了指导。
