在长期使用PD-1抑制剂治疗后,辐射触发的牛皮形皮疹与全身传播:一个病例报告
Mingjun Wu1,2, Qian Yang2,3, Yan Hou1,2
1Respiratory, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu Province, China.
Medicine
|November 8, 2025
概括
延迟牛皮型皮疹可能发生在长时间的细胞死亡蛋白1 (PD-1) 抑制剂治疗与放射治疗相结合后. 这一案例凸显了接受联合免疫治疗和放射治疗的患者长期皮肤监测的必要性.
科学领域:
- 在瘤学瘤学.
- 皮肤病学 皮肤病学
- 免疫学 免疫学 免疫学
背景情况:
- 编程细胞死亡蛋白1 (PD-1) 抑制剂用于治疗各种癌症.
- 皮肤免疫相关的不良事件 (irAEs),如牛皮型皮疹,在PD-1抑制剂中很常见,通常在治疗的早期出现.
- 在长期使用PD-1抑制剂治疗和放射治疗后,很少报告延迟和全身牛皮型皮疹.
研究的目的:
- 在联合免疫疗法和放射治疗后报告一种罕见的延迟,全身传播的牛皮形皮疹病例.
- 为了强调在开始PD-1抑制剂治疗后很长时间内可能出现严重的皮肤上IRE.
- 强调在接受联合治疗的患者长期皮肤病监测的重要性.
主要方法:
- 一个病例研究,一个患有肺腺癌的老年患者接受了tislelizumab (PD-1抑制剂) 25个月.
- 患者接受了骨转移的立体体辐射疗法.
- 观察和治疗了牛皮形皮疹的发展和进展.
主要成果:
- 治疗后一个月,在放射治疗部位出现了牛皮形皮疹,并在全身传播.
- 用口服普雷迪尼松和局部哈洛梅塔松治疗导致皮疹在4周内显著回归 (>80%).
- 患者经历了的缓解,没有新的病变出现.
结论:
- 这一案例支持了对irAEs的"双击假说",其中长时间的PD-1抑制会产生敏感状态,放射治疗作为触发剂.
- 长期皮肤监测对于接受免疫治疗的患者至关重要,特别是与放射治疗相结合时.
- 严格的皮肤学评估是必要的,以管理延迟和严重的皮肤IRAE.
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