Intracranial Complications From Immune Checkpoint Therapy in a Patient With NSCLC and Multiple Sclerosis: Case Report.
Intracranial Complications From Immune Checkpoint Therapy in a Patient With NSCLC and Multiple Sclerosis: Case Report.
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DOI：
10.1016/j.jtocrr.2021.100183
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发表时间：
2021-06
影响因子：
--
通讯作者：
Goldberg SB
中科院分区：
文献类型：
--
作者：
Lu BY;Isitan C;Mahajan A;Chiang V;Huttner A;Mitzner JR;Wesley SF;Goldberg SB
免疫检查点抑制剂（ICI）已成为癌症治疗中越来越重要的工具，在几种不同类型的肿瘤（包括NSCLC）中显示出持久的反应。然而，ICI具有免疫介导的毒性风险。在自身免疫性疾病（如多发性硬化症（MS））患者中同时使用这些药物的数据很少。我们报告了一例有MS和转移性NSCLC脑转移病史的男性患者，在接受化疗、全脑放疗和立体定向放射外科治疗脑病变后出现癌症进展，并接受程序性死亡配体1抑制剂atezolizumab治疗。他有显著的临床和影像学获益，但出现严重的MS发作和神经功能下降，无法进一步治疗。先前放射性脑损伤的相当大的生长促使切除，病理结果与放射性坏死和脱髓鞘一致，没有存活的肿瘤细胞。尽管既存自身免疫性疾病（包括MS）患者发生免疫相关不良事件的风险可能增加，但他们也可能经历抗癌获益。颅内疾病可能具有挑战性，以准确诊断MS患者谁以前接受过放射治疗，因为进展性病变可能是肿瘤生长，MS耀斑，或放射性坏死。
Immune checkpoint inhibitors (ICIs) have become an increasingly important tool in cancer treatment, revealing durable responses in several different types of tumors, including NSCLCs. Nevertheless, ICIs carry a risk of immune-mediated toxicities. There is a paucity of data for concurrent use of these agents in patients with autoimmune disorders, such as multiple sclerosis (MS). We report a case of a man with a history of MS and metastatic NSCLC with brain metastases who had cancer progression after receiving chemotherapy, whole-brain radiation therapy, and stereotactic radiosurgery to brain lesions and was treated with the programmed death-ligand 1 inhibitor, atezolizumab. He had dramatic clinical and radiographic benefit but developed a severe MS flare and neurologic decline precluding further treatment. Considerable growth of a previously radiated brain lesion prompted resection, with pathologic findings consistent with radiation necrosis and demyelination without viable tumor cells. Although patients with preexisting autoimmune diseases, including MS, might be at an increased risk of developing immune-related adverse events with ICIs, they may also experience anticancer benefit. Intracranial disease can be challenging to accurately diagnose in a patient with MS who previously underwent radiation, as progressing lesions can be tumor growth, MS flare, or radiation necrosis.
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DOI：
10.1016/j.ijrobp.2011.02.056
发表时间：
2011-11-15
影响因子：
7
作者：
Lowell, Dot;Tatter, Stephen B.;Chan, Michael D.
通讯作者：
Chan, Michael D.
影响因子：
5.4
作者：
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通讯作者：
Bakshi, Rohit
影响因子：
45.3
作者：
Leonardi, Giulia C.;Gainor, Justin F.;Awad, Mark M.
通讯作者：
Awad, Mark M.
影响因子：
4.1
作者：
Colaco, Rovel J.;Martin, Pierre;Chiang, Veronica L.
通讯作者：
Chiang, Veronica L.