非小细胞肺癌中发生亚临床免疫检查点抑制剂相关性心肌炎 1 例
A case of subclinical immune checkpoint inhibitor-associated myocarditis in non-small cell lung cancer.
机构信息
Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
Cancer Center, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
出版信息
BMC Pulm Med. 2023 Apr 14;23(1):119. doi: 10.1186/s12890-023-02417-4.
BACKGROUND
Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of cancer. Moreover, immune-related adverse events (irAEs) have become a new clinical challenge. ICI-associated myocarditis is a rare but fatal condition among diverse organ injuries, and early recognition and effective interventions are critical for patients.
CASE PRESENTATION
In this report, we present the case of a healthy 60-year-old male who was diagnosed with lung squamous cell carcinomas following chemotherapy and received ICIs. The patient presented with asymptomatic cardiac biomarker elevation followed by immune-related myocarditis. Fortunately, the patient achieved a good clinical result after receiving high-dose steroids. The treatment with ICIs was discontinued because of recurrent increases in troponin T.
CONCLUSION
ICI-mediated associated myocarditis is an uncommon but potentially life-threatening adverse event. The current data suggest that clinicians need to be cautious about reinitiation in low-grade patients; however, further study of the diagnosis and treatment is necessary.
背景
免疫检查点抑制剂（ICI）已广泛应用于癌症的治疗。此外，免疫相关不良事件（irAEs）已成为新的临床挑战。ICI 相关性心肌炎是多种器官损伤中罕见但致命的病症，早期识别和有效干预对患者至关重要。
病例介绍
本报告介绍了一例健康的 60 岁男性病例，该患者在化疗后被诊断为肺鳞癌，并接受了 ICI 治疗。患者出现无症状的心脏生物标志物升高，随后发生免疫相关性心肌炎。幸运的是，患者在接受大剂量类固醇治疗后取得了良好的临床效果。由于肌钙蛋白 T 反复升高，ICI 治疗被停止。
结论
ICI 介导的相关性心肌炎是一种不常见但潜在危及生命的不良事件。目前的数据表明，对于低级别患者，临床医生需要谨慎考虑重新开始治疗；然而，进一步研究诊断和治疗是必要的。
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