Diaz-Rodriguez Porfirio E, Muns-Aponte Claudia M, Velazquez-Acevedo Sharolyn I, Ortiz-Malave Cristina M, Acevedo Jose, Merced-Ortiz Francisco G
Cardiology, Veterans Affairs Medical Center, San Juan, PRI.
Internal Medicine, Veterans Affairs Medical Center, San Juan, PRI.
Cureus. 2023 Aug 17;15(8):e43628. doi: 10.7759/cureus.43628. eCollection 2023 Aug.
Tumor immunotherapy is an important clinical strategy for the treatment of various solid and hematological malignancies, and its use is on the rise. Immune checkpoint inhibitors (ICIs) are immunotherapies that boost anticancer immune responses by targeting receptors on the surface of T-lymphocytes. Two important ICIs are anti-programmed death ligand-1 (anti-PD-L1) monoclonal antibodies and anti-cytotoxic T-lymphocyte-associated antigen-4 (anti-CTLA-4) monoclonal antibodies. Tremelimumab (anti-CTLA-4) and durvalumab (anti-PD-L1) have been shown to be effective monotherapies. However, their combination has demonstrated effective and encouraging antitumor activity with manageable safety in patients with unresectable hepatocellular carcinoma. We present the case of an 80-year-old male with hepatocellular carcinoma who had undergone drug-eluting bead transarterial chemoembolization (DEB-TACE) on three occasions and had been started on a combination of ICIs, durvalumab, and tremelimumab. He subsequently developed various immune-related adverse effects in different organ systems, including hepatic and cardiovascular complications. Appropriate treatment was administered, but ultimately, he passed away. We aim to discuss the initial evaluation for suspected immune-related adverse events, specifically those related to myocarditis and its various manifestations, prognosis, and treatment.
肿瘤免疫疗法是治疗各种实体瘤和血液系统恶性肿瘤的重要临床策略，其应用正在增加。免疫检查点抑制剂（ICIs）是一类通过靶向T淋巴细胞表面受体来增强抗癌免疫反应的免疫疗法。两种重要的ICIs是抗程序性死亡配体1（抗PD-L1）单克隆抗体和抗细胞毒性T淋巴细胞相关抗原4（抗CTLA-4）单克隆抗体。曲美木单抗（抗CTLA-4）和度伐利尤单抗（抗PD-L1）已被证明是有效的单药疗法。然而，它们的联合应用已在不可切除肝细胞癌患者中显示出有效且令人鼓舞的抗肿瘤活性，且安全性可控。我们报告一例80岁肝细胞癌男性患者，该患者曾三次接受载药微球经动脉化疗栓塞术（DEB-TACE），并开始接受ICIs、度伐利尤单抗和曲美木单抗联合治疗。随后，他在不同器官系统出现了各种免疫相关不良反应，包括肝脏和心血管并发症。给予了适当治疗，但最终患者去世。我们旨在讨论对疑似免疫相关不良事件的初始评估，特别是与心肌炎及其各种表现、预后和治疗相关的评估。
