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Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners Nivolumab诱导的甲状腺功能减退伴随之而来的甲状腺功能减退相关性肌病。

影响因子：1.416 DOI：10.1177/1078155219835912

作者： Johnson ED,Kerrigan K,Butler K,Patel SB 发表时间：2020-07-10 19:05:30

from：《JOURNAL OF ONCOLOGY PHARMACY PRACTICE》

keywords： Johnson EDKerrigan KButler KPatel SB

关键词：甲状腺功能减退症免疫检查点抑制剂免疫相关不良事件肌病 Nivolumab

Abstract

PURPOSE:Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD-L1 and PD-L2. In doing so, this immune checkpoint inhibitor removes the negative signal stifling T cell activation and proliferation within the tumor microenvironment and demonstrates favorable antitumor activity. CASE REPORT:We report an interesting case of immune checkpoint inhibitor-induced primary hypothyroidism with associated hypothyroid myopathy in a young patient with surgically resected stage IIIB melanoma receiving adjuvant nivolumab. He presented 12 weeks into therapy with severe myalgias, arthralgias, and intermittent disequilibrium of unclear etiology. Laboratory evaluation demonstrated a significant elevation in thyroid stimulating hormone and creatine kinase with an undetectable free T4 with standard laboratory measurement. With thyroid hormone replacement therapy alone, he had rapid improvement in his musculoskeletal symptoms and laboratory parameters over a three-week period. DISCUSSION:This case emphasizes the serious nature of endocrine immune-related adverse events in patients receiving immune checkpoint inhibitors. Additionally, it highlights that unlike most other immune-related adverse events, endocrine immune-related adverse events can generally be managed with adequate hormone replacement alone with swift improvements in symptoms. This allows patients to continue immune checkpoint inhibitors safely without immunosuppression which may dampen the anti-tumor activity of these agents. CONCLUSION:This case highlights the importance of early recognition and the appropriate management of endocrine immune-related adverse events to maximize patient safety and good outcomes.

摘要

目的: Nivolumab是一种全人IgG4 程序性死亡 1 免疫检查点抑制剂 (ICI) 通过选择性阻断程序性死亡 1 受体与其两个已知的程序性死亡配体PD-L1 和PD-L2 的相互作用而具有抗肿瘤活性的抗体。在这样做时，这种免疫检查点抑制剂消除了肿瘤微环境内抑制T细胞活化和增殖的负信号，并表现出有利的抗肿瘤活性。病例报告: 我们报道了一个有趣的病例，在 1 例接受辅助nivolumab的手术切除IIIB期黑色素瘤的年轻患者中，免疫检查点抑制剂诱导原发性甲状腺功能减退症伴相关甲状腺功能减退性肌病。他在治疗 12 周时出现严重肌痛、关节痛和病因不明的间歇性平衡失调。实验室评价显示促甲状腺激素和肌酸激酶显著升高，标准实验室测量游离T4 检测不到。单纯甲状腺激素替代治疗，他的肌肉骨骼症状和实验室参数在三周的时间内迅速改善。讨论: 本病例强调接受免疫检查点抑制剂的患者内分泌免疫相关不良事件的严重性质。此外，它强调，与大多数其他免疫相关不良事件不同，内分泌免疫相关不良事件通常可以单独使用适当的激素替代治疗，症状迅速改善。这使得患者可以安全地继续免疫检查点抑制剂，而无需免疫抑制，这可能会抑制这些药物的抗肿瘤活性。结论: 本病例强调了早期识别和适当管理内分泌免疫相关不良事件的重要性，以最大限度地提高患者安全性和良好结局。

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