检查点抑制剂诱导的严重免疫媒介性结肠炎在患有林奇综合征的青少年身上
Rachel V Lee1, Kurt A Melstrom2, Rifat Mannan3
1Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, USA.
Cureus
|September 11, 2023
概括
用免疫检查点抑制剂治疗的林奇综合征患者可能会患上严重的结肠炎. 这个案例详细介绍了一个年轻的病人.
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:
- 林奇综合征是一种与DNA不匹配修复基因突变相关的遗传性疾病,增加了结直肠癌的风险.
- 免疫检查点抑制剂 (ICI) 在林奇综合征相关的癌症中显示出有效性,但可以引发与免疫相关的不良事件 (irAEs),特别是结肠炎.
研究的目的:
- 在一个年轻的林奇综合征患者中报告ICI诱导的严重IMC病例.
- 为了强调在这个特定的患者群体中管理严重的IMC的困难.
- 促使进一步调查针对林奇综合征的IMC量身定制的治疗策略.
主要方法:
- 一个20岁的男性患有林奇综合征和质母细胞瘤,接受双重检查点抑制剂治疗的病例报告.
- 尽管初始系统性类固醇治疗,疾病进展的记录.
- 后续治疗的审查,包括infliximab,vedolizumab和手术干预 (完全腹腔切除术与J袋创建).
主要成果:
- 患者患有严重的IMC并发症,包括有毒的大结肠和小肠阻塞.
- 标准治疗 (类固醇,因弗利克西马布,维多利祖马布) 提供了低于最佳的反应.
- 这位患者最终需要用J袋创建全腹切除术.
结论:
- 在林奇综合征患者中管理严重的IMC存在独特的挑战,原因是潜在的治疗耐药性和并发症.
- 这一案例表明,需要探索"治疗到目标"的策略,超出选择患者的IMC症状反应.
- 进一步的研究对于阐明IMC机制和为经历免疫相关不良事件的林奇综合征患者开发个性化治疗方法至关重要.
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