Gohel Shruti, Kalarikkal Zeid, Lavingia Viraj, Mankad Jigar
Medical Oncology, HealthCare Global (HCG) Cancer Center, Ahmedabad, Ahmedabad, IND.
Critical Care, Aurora St. Luke's Medical Center, Milwaukee, USA.
Cureus. 2023 Sep 1;15(9):e44529. doi: 10.7759/cureus.44529. eCollection 2023 Sep.
The use of immune checkpoint inhibitors (ICIs) in early-stage settings has shown promise but can lead to chronic immune-related toxicities known as delayed immune-related adverse events (DIREs). These events, occurring after immunotherapy cessation, can affect various organ systems. Fatal immune-related adverse events (irAEs) are relatively rare but significant. Diagnostic challenges exist in distinguishing DIREs from disease sequelae. Efforts are needed to develop evidence-based strategies for managing DIREs as long-term survival with ICIs becomes possible. This case study highlights delayed neurological immune-related adverse events (NirAEs) encountered during pembrolizumab treatment, emphasizing the need for accurate diagnosis and prompt management. Reporting practices in immunotherapy trials hinder accurate assessment of DIREs. Close monitoring, accurate diagnosis, and timely corticosteroid administration are vital for effective DIRE management.
在早期治疗中使用免疫检查点抑制剂（ICI）已显示出前景，但可能导致被称为延迟性免疫相关不良事件（DIRE）的慢性免疫相关毒性。这些事件发生在免疫治疗停止后，可影响多个器官系统。致命的免疫相关不良事件（irAE）相对罕见但很严重。在区分DIRE与疾病后遗症方面存在诊断挑战。随着使用ICI实现长期生存成为可能，需要努力制定基于证据的DIRE管理策略。本病例研究突出了帕博利珠单抗治疗期间遇到的延迟性神经免疫相关不良事件（NirAE），强调了准确诊断和及时管理的必要性。免疫治疗试验中的报告做法妨碍了对DIRE的准确评估。密切监测、准确诊断和及时给予皮质类固醇对于有效的DIRE管理至关重要。
