Gill Jasmine, Walker John, Ye Carrie
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
University of Alberta, Edmonton, Canada.
J Chemother. 2025 Jul;37(4):372-375. doi: 10.1080/1120009X.2024.2359838. Epub 2024 May 31.
Immune checkpoint inhibitors (ICIs), have emerged to the forefront of management for various advanced cancers, such as melanoma, lung cancer and renal cell carcinoma. Immune checkpoints such as CTLA-4 and PD-1 serve to inhibit T cell activation and signaling; therefore through blockade of these pathways, ICIs promote anti-tumour immune activation. However, as a result of T cell disinhibition, ICIs have been reported to cause immune related adverse events (irAEs) affecting numerous organ systems. One of the most serious and potentially life-threatening irAE is inflammatory myositis. Myositis, which generally presents with progressive proximal muscle weakness and elevated serum creatine kinase (CK), has been reported in <1% of patients who have received ICI therapy. A rare cause of elevated CK is adrenal insufficiency, which has been reported in up to 6% of ICI users. Here we report a case of ICI-related hypophysitis related myopathy that was initially misdiagnosed as ICI-associated inflammatory myositis. This case illustrates the importance of considering a wide differential when assessing hyperCKemia in the setting of ICI use.
免疫检查点抑制剂（ICIs）已成为各种晚期癌症（如黑色素瘤、肺癌和肾细胞癌）治疗的前沿手段。诸如细胞毒性T淋巴细胞相关抗原4（CTLA-4）和程序性死亡受体1（PD-1）等免疫检查点可抑制T细胞活化和信号传导；因此，通过阻断这些途径，免疫检查点抑制剂可促进抗肿瘤免疫激活。然而，由于T细胞去抑制作用，据报道免疫检查点抑制剂会导致影响多个器官系统的免疫相关不良事件（irAEs）。最严重且可能危及生命的免疫相关不良事件之一是炎性肌炎。肌炎通常表现为进行性近端肌无力和血清肌酸激酶（CK）升高，在接受免疫检查点抑制剂治疗的患者中报告的发生率<1%。CK升高的一个罕见原因是肾上腺功能不全，在高达6%的免疫检查点抑制剂使用者中曾有报告。在此，我们报告一例与免疫检查点抑制剂相关的垂体炎相关性肌病病例，该病例最初被误诊为免疫检查点抑制剂相关的炎性肌炎。该病例说明了在免疫检查点抑制剂使用背景下评估高肌酸激酶血症时考虑广泛鉴别诊断的重要性。
