Zhang Mingbo, Fu Yang, Song Yuxiao, Gao Xia, Wang Jun, Zhang Bicheng
Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Oncology and Hematology, Xiangyang Hospital, Hubei University of Chinese Medicine, Xiangyang, China.
Front Pharmacol. 2024 Oct 18;15:1454015. doi: 10.3389/fphar.2024.1454015. eCollection 2024.
Monoclonal antibodies against programmed cell death protein-1 (PD-1)/programmed death-ligand-1 (PD-L1) have emerged as critical tools in cancer treatment. However, concerns regarding their potential cutaneous and mucosal toxicity, along with severe complications, have drawn clinical attention. Further research is warranted to investigate the adverse reactions and treatment strategies associated with PD-1 monoclonal antibodies.
We present a detailed case report of a laryngeal cancer patient who developed toxic epidermal necrolysis (TEN) after treatment with PD-1 monoclonal antibody. We analyzed the etiology, diagnosis, and treatment approaches by integrating clinical manifestations, pathological examinations, and literature research.
After PD-1 monoclonal antibody therapy, the patient exhibited systemic rash, bullae, and epidermal detachment, which subsequently involved the tracheal and bronchial mucosa, resulting in dyspnea. The patient recovered after treatments with steroids, macrolides, immunoglobulins, and etanercept, along with repeated removal of scabs via bronchoscopy. Literature reviewing suggests a potential association between PD-1 monoclonal antibodies and the pathogenesis of Steven Johnson's Syndrome (SJS) and Toxic epidermal necrolysis (TEN), possibly due to immune dysregulation. Treatment consists of immediate discontinuation of suspicious drugs, essential supportive therapy, and systemic corticosteroid administration, with the addition of immunosuppressants and/or immunoglobulins needed.
The mucocutaneous toxicity induced by PD-1 monoclonal antibodies is not limited to the surface of the skin but also in deep mucosal layers, potentially leading to life-threatening complications. Therefore, when using PD-1 monoclonal antibodies, clinicians should closely monitor adverse events and apply appropriate treatments as soon as possible to prevent severe complications.
抗程序性细胞死亡蛋白1（PD-1）/程序性死亡配体1（PD-L1）单克隆抗体已成为癌症治疗的关键工具。然而，对其潜在的皮肤和黏膜毒性以及严重并发症的担忧已引起临床关注。有必要进行进一步研究以调查与PD-1单克隆抗体相关的不良反应和治疗策略。
我们报告了1例喉癌患者在接受PD-1单克隆抗体治疗后发生中毒性表皮坏死松解症（TEN）的详细病例。我们通过整合临床表现、病理检查和文献研究分析了病因、诊断和治疗方法。
接受PD-1单克隆抗体治疗后，患者出现全身性皮疹、水疱和表皮剥脱，随后累及气管和支气管黏膜，导致呼吸困难。患者在接受类固醇、大环内酯类药物、免疫球蛋白和依那西普治疗以及通过支气管镜反复清除痂皮后康复。文献综述表明，PD-1单克隆抗体与史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）的发病机制之间可能存在关联，可能是由于免疫失调所致。治疗包括立即停用可疑药物、必要的支持治疗和全身性皮质类固醇给药，必要时加用免疫抑制剂和/或免疫球蛋白。
PD-1单克隆抗体引起的皮肤黏膜毒性不仅限于皮肤表面，还累及深部黏膜层，可能导致危及生命的并发症。因此，使用PD-1单克隆抗体时，临床医生应密切监测不良事件并尽早采取适当治疗措施以预防严重并发症。
