Dai Cong, Huang Yu-Hong
Gastroenterology, First Affiliated Hospital, China Medical University, china.
Gastroenterology, First Affiliated Hospital, China Medical University.
Rev Esp Enferm Dig. 2024 Jul;116(7):383-384. doi: 10.17235/reed.2023.9796/2023.
Immune checkpoint inhibition therapy using targeted monoclonal antibodies is a relatively new therapeutic approach for patients with several cancer types including non-small cell lung cancer1. Targeted monoclonal antibodies based drugs can activate anti-tumor immunity by blocking immune checkpoint receptors (CTLA-4, PD-1 receptor and its ligand PD-L1), in order to restore T-cell effector function2,3. However, the use of immune checkpoint inhibitors can lead to a unique side effect profile termed as immune-related adverse events (irAEs). Loss of T-cell inhibition results in an enhanced immune response driven by T-cell activation and is capable of inducing an autoimmune-related inflammation in normal tissue as a consequence of impaired self tolerance4. These irAEs can potentially involve every organ system including gastrointestinal, dermatologic, hepatic, and endocrine toxicities. For example, Fernandez-Gordon Sanchez et al reported a patient with immune-mediated colitis and nonimmune-mediated cholestasic injury induced by pembrolizumab that was successfully treated with Ustekinumab5. We report a steroid-refractory case of lung adenocarcinoma patient with an unusual irAE (intestinal pseudo-obstruction) during the treatment with immune checkpoint inhibitors that could be successfully managed by the administration of infliximab.
使用靶向单克隆抗体的免疫检查点抑制疗法是包括非小细胞肺癌在内的几种癌症类型患者的一种相对较新的治疗方法。基于靶向单克隆抗体的药物可通过阻断免疫检查点受体（CTLA-4、PD-1受体及其配体PD-L1）来激活抗肿瘤免疫，以恢复T细胞效应功能。然而，使用免疫检查点抑制剂会导致一种独特的副作用，称为免疫相关不良事件（irAE）。T细胞抑制的丧失导致由T细胞激活驱动的免疫反应增强，并由于自身耐受性受损而能够在正常组织中诱导自身免疫相关炎症。这些irAE可能潜在地累及每个器官系统，包括胃肠道、皮肤、肝脏和内分泌毒性。例如，费尔南德斯-戈登·桑切斯等人报告了一名由派姆单抗诱导的免疫介导性结肠炎和非免疫介导性胆汁淤积性损伤的患者，该患者接受乌司奴单抗治疗成功。我们报告了一例肺腺癌患者在免疫检查点抑制剂治疗期间出现不寻常的irAE（肠道假性梗阻）且对类固醇难治的病例，该病例通过英夫利昔单抗治疗成功得到控制。
