Lanzafame Katia, Blanco Giusi, D'Asta Marco, Sapienza Mirella, Bonanno Giulia Maria, Ettore Carla, Giurato Eliana, Paratore Sabrina, Russo Angela, Vallone Antonino, Bordonaro Roberto, Ettore Giuseppe
Department of Oncology Medical, Azienda di Rilievo Nazionale ed Alta Specializzazione Garibaldi Catania, Catania, Italy.
Department of Gynecological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione Garibaldi Catania, Catania, Italy.
AME Case Rep. 2025 Jun 16;9:82. doi: 10.21037/acr-24-239. eCollection 2025.
Several studies have demonstrated the effectiveness of anti-programmed death-1 (PD-1) drugs in patients suffering from deficient mismatch repair/microsatellite instability (dMMR/MSI) endometrial cancer (EC). The phase III Ruby study, showed benefit in progression-free survival (PFS) for patients with stage III-IV EC, both MSI-high/dMMR (MSI-H/dMMR) and mismatch repair proficient/microsatellite stable (pMMR/MSS), treated upfront with chemotherapy in combination with dostarlimab. Even earlier, the GARNET trial, which enrolled patients with advanced or relapsed EC with dMMR and/or MSI progressing on prior platinum therapy to receive dostarlimab, reported overall response rate (ORR) of 43.5% with a manageable safety profile. We report on the case of an elderly patient with many pathologies treated with dostarlimab.
A 75-year-old woman with EC (MSI-H) with pulmonary and bone metastasis progressed on first line chemotherapy platinum-containing, was treated with dostarlimab as monotherapy. Medical history was positive for arterial hypertension, autoimmune thrombocytopenia and allergy to amoxicillin and levofloxacin. After the second administration of dostarlimab, our patient showed a dramatic improvement of her clinical conditions. The clinical response was confirmed by radiological response on the basis of the results of a computed tomography (CT) scan performed in March 2023 that showed a reduction of the pelvic mass and pulmonary secondaries. No toxicities related to autoimmune thrombocytopenia occurred. The experienced grade 2 infusion reaction, resolved with the suspension of the drug and the administration of an antihistaminic drug; then we resumed dostarlimab doubling the administration time.
The administration of dostarlimab is safe and feasible in elderly people with multiple pathologies and multiple allergies with recurrent dMMR/MSI EC. The drug is well tolerated and able to give a good quality of life to patients.
多项研究已证明抗程序性死亡-1（PD-1）药物对患有错配修复缺陷/微卫星不稳定（dMMR/MSI）子宫内膜癌（EC）的患者有效。III期Ruby研究表明，对于III-IV期EC患者，无论微卫星高度不稳定/错配修复缺陷（MSI-H/dMMR）还是错配修复功能正常/微卫星稳定（pMMR/MSS），一线接受化疗联合多斯塔利单抗治疗可使无进展生存期（PFS）获益。更早之前，GARNET试验纳入了先前铂类治疗进展的晚期或复发性dMMR和/或MSI的EC患者，接受多斯塔利单抗治疗，报告的总缓解率（ORR）为43.5%，安全性可控。我们报告了一例接受多斯塔利单抗治疗的患有多种疾病的老年患者的病例。
一名75岁患有EC（MSI-H）并伴有肺和骨转移的女性患者，一线含铂化疗进展后，接受多斯塔利单抗单药治疗。病史显示患有动脉高血压、自身免疫性血小板减少症，对阿莫西林和左氧氟沙星过敏。第二次给予多斯塔利单抗后，我们的患者临床状况显著改善。2023年3月进行的计算机断层扫描（CT）结果显示盆腔肿块和肺转移灶缩小，影像学反应证实了临床反应。未发生与自身免疫性血小板减少症相关的毒性反应。出现2级输注反应，通过暂停用药和给予抗组胺药物得以解决；然后我们恢复多斯塔利单抗治疗，将给药时间加倍。
对于患有多种疾病和多种过敏的复发性dMMR/MSI EC老年患者，给予多斯塔利单抗是安全可行的。该药物耐受性良好，能够为患者提供良好的生活质量。
