复发性不耐药免疫检查点抑制剂诱导的大肠炎,用塔克罗利斯治疗,并用vedolizumab维持
Shohei Igarashi1, Koji Shimaya2, Kota Fujimaki2
1Department of Gastroenterology, Aomori Prefectural Central Hospital, 2-1-1, Higashi-Tsukurimichi, Aomori City, Aomori, Japan. s.igarsahi.1989@gmail.com.
Clinical journal of gastroenterology
|April 25, 2025
概括
塔克罗利斯有效地治疗了肺癌患者耐药性免疫相关不良事件 (irAE) 大肠炎. 维多利祖马布提供了成功的维持疗法,使得类固醇和塔克罗利斯的停用成为可能.
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),如抗PD-L1和抗CTLA-4,可以引起与免疫相关的不良事件 (irAEs).
- 与免疫相关的不良事件结肠炎是ICI治疗的显著胃肠道并发症.
- 耐药病例带来了治疗挑战,需要探索替代治疗策略.
研究的目的:
- 报告一种耐药性免疫相关不良事件结肠炎的病例.
- 评估包括塔克罗利斯和维多利祖马布在内的新疗法的疗效.
- 为突出重症,复发性IRAE大肠炎的治疗选择.
主要方法:
- 一名患有肺癌和大脑转移的患者接受了ICI治疗.
- 发展出与免疫相关的不良事件结肠炎,最初用普雷迪尼索隆和5-氨基酸治疗.
- 随后的复发是用各种药物来控制的,包括因弗利西玛布,粒细胞-单细胞非雷斯,乌斯特基努马布,塔克罗利斯和维多利祖马布.
主要成果:
- 最初的普雷迪尼索隆治疗提供了暂时的缓解.
- 尽管使用了标准和先进疗法,但发生了多次复发.
- 塔克罗利斯在一个耐火病例中导致症状迅速消失.
- 维多利祖马布作为维持疗法实现了持续的缓解,允许类固醇和塔克罗利斯的停药.
结论:
- 塔克罗利莫斯在治疗复发性耐火性IRAE大肠炎方面显示出潜在的有效性,特别是在因弗利西马布和其他治疗失败时.
- 维多利祖马布作为经常复发的irAE大肠炎的可行的维持疗法,促进类固醇节约和药物停用.
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