心肌炎模仿Takotsubo心肌病症与第一剂新辅助剂Nivolumab-Relatlimab的治疗
Rohit Rao1,2, Felicia Tejawinata2, Tejasi Sachdeva1
1Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA.
Case reports in oncological medicine
|December 31, 2025
概括
治疗黑色素瘤的新辅助药尼沃卢马布-relatlimab可以引起心脏免疫相关不良事件 (irAEs),如Takotsubo心肌病变. 早期的皮质类固醇治疗使老年患者完全康复,强调了迅速识别和管理这些事件的重要性.
科学领域:
- 在瘤学瘤学.
- 心脏病学 心脏病学
- 免疫学 免疫学 免疫学
背景情况:
- 新辅助性免疫检查点抑制剂 (ICI),包括nivolumab-relatlimab,是治疗III期黑色素瘤的标准.
- 这些治疗带有免疫相关不良事件 (irAEs) 的风险,特别是心脏irAEs,如心肌炎.
- 塔科茨博心肌病 (TTC) 是一种已知的心脏性心肌病,但其确切的机制尚不清楚,特别是将其与心肌炎区分开来.
研究的目的:
- 报告Takotsubo心肌病症 (TTC) 作为免疫相关不良事件 (irAE) 的病例,该病例发生在治疗III期黑色素瘤的新辅助药nivolumab-relatlimab的患者中.
- 突出诊断挑战和成功管理心脏irAEs在这个环境中.
- 强调早期识别和皮质类固醇干预对于预防严重并发症的重要性.
主要方法:
- 一个老年患者的病例报告,患有III期黑色素瘤,有心力衰竭史,中等射出分数.
- 该患者接受了新辅助药尼沃卢马布-雷拉利马布,随后出现心脏功能障碍的症状.
- 诊断工作包括心脏磁共振 (CMR) 成像;治疗涉及高剂量的甲基前素,其次是前素逐渐减少.
主要成果:
- 患者在第一剂nivolumab-relatlimab后出现呼吸短促.
- 通过CMR成像显示TTC与严重的顶端低运动,但没有心肌胀,排除了显著的心肌炎.
- 在接受皮质类固醇治疗后,CMR检测结果在44天内恢复到基线,实现了完全的心脏恢复. 该患者还对黑色素瘤治疗产生了主要的病理反应.
结论:
- 在接受新辅助尼沃卢马布-雷拉特利马布治疗黑色素瘤的患者中,Takotsubo心肌病症可以表现为心脏IRAE.
- 早期识别心脏IRAE和及时启动皮质类固醇治疗对于有利的结果和预防长期心脏病发作至关重要.
- 这一案例强调了在接受ICI组合治疗的患者心脏毒性方面需要保持警.
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