Gosser Caroline, Al Bawaliz Anas, Bahaj Waled, Chesney Jason, Ranjan Smita
Internal Medicine, University of Louisville School of Medicine, Louisville, USA.
Hematology and Medical Oncology, University of Louisville Hospital, Louisville, USA.
Cureus. 2023 Nov 18;15(11):e49007. doi: 10.7759/cureus.49007. eCollection 2023 Nov.
Immune checkpoint inhibitors (ICIs) have considerably changed the management of several malignancies. Although these agents transformed the scope of management in oncology and proved long-term efficacy, they have been associated with numerous autoimmune-related adverse events. We presented a case of a 61-year-old male with a history of non-small cell lung cancer (NSCLC) who presented with respiratory failure requiring mechanical ventilation. He was discharged with a working diagnosis of myasthenia gravis crisis secondary to the use of pembrolizumab. On further evaluation, he was found to possibly have pembrolizumab-induced myositis. He was treated with plasmapheresis, methylprednisolone, and rituximab and achieved significant improvement. Pembrolizumab, a monoclonal antibody, is an ICI that targets programmed death protein 1 (PD-1), thereby blocking the interaction between PD-1 and PDL-1, leading to an enhancement of T-cell mediated immune response against tumor cells. Pembrolizumab has been used to treat a variety of malignancies including melanoma, NSCLC, and other solid tumors. Though ICIs have revolutionized the field of oncology, they should be used with caution. ICIs can cause immune-related adverse events (irAEs), including myasthenia gravis and myositis. Diagnosing irAEs is challenging due to their nonspecific presentations and lack of antibody markers. Therefore, patients and clinicians should be aware of irAEs in order to initiate timely intervention.
免疫检查点抑制剂（ICIs）极大地改变了几种恶性肿瘤的治疗方式。尽管这些药物改变了肿瘤学的治疗范围并证明了其长期疗效，但它们与众多自身免疫相关的不良事件有关。我们报告了一例61岁男性非小细胞肺癌（NSCLC）患者，该患者因呼吸衰竭需要机械通气。出院时初步诊断为使用派姆单抗继发重症肌无力危象。进一步评估发现，他可能患有派姆单抗诱导的肌炎。他接受了血浆置换、甲泼尼龙和利妥昔单抗治疗，病情有显著改善。派姆单抗是一种单克隆抗体，是一种靶向程序性死亡蛋白1（PD-1）的ICIs，从而阻断PD-1与PDL-1之间的相互作用，导致T细胞介导的针对肿瘤细胞的免疫反应增强。派姆单抗已被用于治疗多种恶性肿瘤，包括黑色素瘤、NSCLC和其他实体瘤。尽管ICIs彻底改变了肿瘤学领域，但使用时应谨慎。ICIs可导致免疫相关不良事件（irAEs），包括重症肌无力和肌炎。由于irAEs表现不特异且缺乏抗体标志物，诊断具有挑战性。因此，患者和临床医生应了解irAEs以便及时进行干预。
