在耐火性免疫检查点抑制剂 (ICI) 中介性结肠炎中反映UC护理途径:独特的特征和常见途径
Joseph Sleiman1, Rhonda M Brand1,2, Reetesh Pai3
1Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
免疫检查点抑制剂可以导致严重的腹和结肠炎. 一种JAK抑制剂托法西替尼 (tofacitinib) 有效地治疗了一名耐耐药免疫媒介腹和大肠炎的患者,这表明它在治疗这种疾病方面的潜力.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
背景情况:
- 免疫检查点抑制剂 (ICI) 已经彻底改变了癌症治疗,但可以导致免疫媒介腹和结肠炎 (imDC).
- imDC影响高达20%的患者,与抗PD-1药物相比,抗CTLA-4药物的发病率更高.
- 目前的治疗包括类固醇,抗TNFα和抗α4β7整合蛋白疗法,但耐火病例构成了管理挑战.
研究的目的:
- 报告一种耐药性免疫媒介性腹和结肠炎 (imDC) 病例,该病例已成功用tofacitinib治疗.
- 探索潜在的imDC背后的机制和JAK抑制的有效性.
主要方法:
- 在ICI治疗后,68岁的女性患者患有耐火性imDC的病例报告.
- 用皮质类固醇,infliximab 和 vedolizumab 的治疗失败.
- 托法西提尼布 (一种泛-JAK抑制剂) 的使用,以及临床,生化和免疫组织化学反应的评估.
主要成果:
- 患者经历了tofacitinib治疗后imDC的快速临床,生化和免疫组织化学控制.
- 组织病理学分析显示,受影响组织中T细胞的丰富程度显著.
- 托法西替尼在一种类固醇和生物耐药性imDC病例中显示出有效性.
结论:
- 托法西提尼布是免疫检查点抑制剂治疗后耐药性免疫媒介性腹和结肠炎 (imDC) 的潜在治疗选择.
- 成功的治疗强调了融合性炎症途径在imDC中的作用.
- 需要对imDC的JAK抑制进行进一步的研究.
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