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免疫治疗相关心肌炎患者再挑战的耐受性:病例报告及文献复习。

Tolerated Re-Challenge of Immunotherapy in a Patient with ICI Associated Myocarditis: A Case Report and Literature Review.

机构信息

The Legacy Heritage Cancer Center & Larry Norton Institute, Soroka Medical Center, Beer Sheva 84105, Israel.

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.

出版信息

Medicina (Kaunas). 2023 Nov 3;59(11):1946. doi: 10.3390/medicina59111946.

Abstract

Many different types of cancer can be treated with immunotherapy drugs called immune checkpoint inhibitors (ICIs). These drugs have altered the landscape of cancer treatment options since they function by triggering a stronger immune response to malignancy. As expected, ICIs' modification of immune regulatory controls leads to a wide range of organ/gland-specific immune-related side effects. These adverse effects are uncommonly deadly and typically improve by discontinuing treatment or administering corticosteroid drugs. As a result of a number of factors-including a lack of specificity in the clinical presentation, the possibility of overlap with other cardiovascular and general medical illnesses, difficulties in diagnosis, and a general lack of awareness-the true incidence of ICI-associated myocarditis is likely underestimated. Currently, protocols for the surveillance, diagnosis, or treatment of this condition are unclear. Several questions remain unanswered, such as how to best screen for this rare toxin, what tests should be run on patients who are suspected of having it, how to treat myocarditis once it has developed, and who is at most risk. In this article, we provide a case study of ICI-associated myocarditis and explain its key characteristics and treatment options.

摘要

许多不同类型的癌症可以用称为免疫检查点抑制剂(ICI)的免疫疗法药物治疗。自这些药物通过触发对恶性肿瘤更强的免疫反应来发挥作用以来,它们改变了癌症治疗选择的格局。正如预期的那样,ICI 对免疫调节控制的改变导致了广泛的器官/腺体特异性免疫相关副作用。这些不良反应并不常见且致命,通常通过停止治疗或给予皮质类固醇药物即可改善。由于多种因素的影响,包括临床表现缺乏特异性、与其他心血管和一般医学疾病重叠的可能性、诊断困难以及普遍缺乏认识,ICI 相关性心肌炎的实际发病率可能被低估。目前,该疾病的监测、诊断或治疗方案尚不清楚。还有一些问题尚未得到解答,例如如何最好地筛查这种罕见毒素,对疑似患有该毒素的患者应进行哪些检查,一旦发生心肌炎如何治疗,以及谁的风险最大。在本文中,我们提供了一个与 ICI 相关的心肌炎的病例研究,并解释了其关键特征和治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5733/10673034/348c10b36239/medicina-59-01946-g001.jpg

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