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伊匹单抗和纳武单抗联合治疗透明细胞肾细胞癌引起的细胞因子释放综合征伴相对肾上腺皮质功能不全

Cytokine Release Syndrome with Relative Adrenal Insufficiency Induced by Ipilimumab and Nivolumab Combination Therapy for Clear Cell Renal Cell Carcinoma.

作者信息

Yamamoto Kohei, Shiotsu Shinsuke, Sasakura Misaki, Tanaka Shunya, Goda Shiho, Tsuji Taisuke, Yuba Tatsuya, Takumi Chieko, Hiraoka Noriya

机构信息

Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan.

Department of Clinical Oncology, Japanese Red Cross Kyoto Daiichi Hospital, Japan.

出版信息

Intern Med. 2024 Oct 1;63(19):2703-2707. doi: 10.2169/internalmedicine.3115-23. Epub 2024 Mar 4.

Abstract

Combination therapy with ipilimumab and nivolumab is indicated for many types of cancers; however, several patients experience immune-related adverse events (irAEs). We herein report a case of cytokine release syndrome (CRS) in a 63-year-old woman with stage IV left clear cell renal cell carcinoma. Our patient developed CRS while taking prednisolone, 43 days after the start of ipilimumab and nivolumab administration. The patient was treated with steroid pulse therapy, which improved the symptoms of shock and respiratory failure. Increased vascular permeability and relative adrenal insufficiency are considered to be the main pathogeneses. The early administration of high-dose steroids is crucial as a replacement for corticosteroids.

摘要

伊匹木单抗和纳武单抗联合疗法适用于多种类型的癌症;然而,有部分患者会出现免疫相关不良事件(irAEs)。我们在此报告一例63岁左肾透明细胞癌IV期女性患者发生细胞因子释放综合征(CRS)的病例。我们的患者在开始使用伊匹木单抗和纳武单抗治疗43天后,在服用泼尼松龙期间出现了CRS。患者接受了类固醇冲击疗法,症状性休克和呼吸衰竭得到改善。血管通透性增加和相对肾上腺功能不全被认为是主要发病机制。早期给予高剂量类固醇作为皮质类固醇的替代治疗至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8859/11518607/1fcdc61f1cb2/1349-7235-63-2703-g001.jpg

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