Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, P. R. China.
Guangxi Health Commission Key Laboratory of Prevention and Treatment for Oral Infectious Diseases, Nanning, P. R. China.
BMC Oral Health. 2024 Oct 18;24(1):1240. doi: 10.1186/s12903-024-05036-5.
Cadonilimab is the first approved dual immune checkpoint inhibitor targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), currently utilized for the treatment of various solid tumors. Oral mucosal adverse reactions, such as oral lichenoid lesions, represent one of the most prevalent immune-related adverse events associated with immune checkpoint antibodies. However, reports detailing oral side effects specifically linked to Cadonilimab are lacking. Documenting these side effects is essential to alert oncologists and stomatologists, facilitating timely intervention for affected patients.
We present a case involving a 35-year-old male patient diagnosed with hepatocellular carcinoma who received Cadonilimab following hepatectomy and subsequently developed extensive oral lichenoid lesions along with mucosal erosion at 13-14 weeks post-treatment initiation. A biopsy was conducted revealing immunohistochemical findings of CD3+, CD4+, CD8+, CD20 + lymphocytes, CD68 + macrophages, and α-SMA + myofibroblasts infiltrating the tissue of the oral lichenoid lesions. The patient's oral lesions improved after administration of systemic and local glucocorticoid therapy alongside cessation of Cadonilimab treatment.
This report marks the first documented instance of an oral adverse effect associated with Cadonilimab use. It underscores that administration of this agent may lead to significant lichenoid lesions and erosions within the oral cavity-an issue warranting increased vigilance from both oncologists and stomatologists.
卡度尼利单抗是首个获批的针对程序性死亡蛋白 1（PD-1）和细胞毒性 T 淋巴细胞相关蛋白 4（CTLA-4）的双免疫检查点抑制剂，目前用于治疗多种实体瘤。口腔黏膜不良反应，如口腔类扁平苔藓，是与免疫检查点抗体相关的最常见免疫相关不良反应之一。然而，目前缺乏详细描述卡度尼利单抗特定口腔副作用的报告。记录这些副作用对于提醒肿瘤学家和口腔医生至关重要，以便及时为受影响的患者进行干预。
我们报告了一例 35 岁男性患者，该患者在肝癌切除术后接受卡度尼利单抗治疗，随后在治疗开始后 13-14 周出现广泛的口腔类扁平苔藓和黏膜糜烂。进行活检显示口腔类扁平苔藓组织中存在 CD3+、CD4+、CD8+、CD20+淋巴细胞、CD68+巨噬细胞和α-SMA+肌纤维母细胞的免疫组织化学发现。在停止卡度尼利单抗治疗并给予全身和局部糖皮质激素治疗后，患者的口腔病变得到改善。
本报告首次记录了与卡度尼利单抗使用相关的口腔不良反应。这表明该药物的给药可能导致口腔内明显的类扁平苔藓病变和糜烂——这是肿瘤学家和口腔医生都需要更加警惕的问题。
