信迪利单抗联合奥沙利铂和替吉奥治疗贲门腺癌致免疫性心肌炎并文献分析

Immune-related myocarditis due to combination of sintilimab, oxaliplatin and tegafur gimercil and oteracil porassium capsule for gastric cardia adenocarcinoma and literature review

摘要:

报道1例64岁女性患者因贲门腺癌行信迪利单抗（200 mg， d1）+奥沙利铂（200 mg， d1）+替吉奥（60 mg， bid， d1~14）的3周治疗方案。患者在第2周期治疗的第7天出现后背疼痛，心肌损伤标志物升高，心电图Ⅲ、aVF导联可见异常Q波，T波低平。经冠脉CT检查后排除冠状动脉粥样硬化所致冠心病，诊断为免疫性心肌炎。停用抗肿瘤药物，给予甲泼尼龙治疗9 d后症状缓解，心肌损伤标志物明显下降。免疫性心肌炎是信迪利单抗罕见且严重的不良反应，临床应用信迪利单抗时应密切监测心肌损伤标志物的变化和患者的症状、体征。

Abstract:

A 64-year-old female patient received a 3-week treatment regimen of sintilimab (200 mg, d1), oxaliplatin (200 mg, d1) and tegafur gimercil and oteracil porassium capsule (60 mg, bid， d1~14) for gastric cardia adenocarcinoma. On the 7th day of the second cycle of treatment, the patient developed backache. Laboratory tests showed abnormal cardiac biomarkers. ECG presented abnormal Q waves in leads III and aVF, and flat T waves. After excluded from atherosclerosis-induced coronary artery disease via coronary CT scan, the patient was then diagnosed with immune-related myocarditis. The anti-cancer drugs were discontinued, and the patient was treated with methylprednisolone for 9 days, after which the symptoms relieved and the values of cardiac injury markers significantly decreased. Myocarditis is a rare and severe adverse effect of sintilimab, thus clinicians should closely monitor changes in cardiac injury markers and symptoms in patients receiving this drug.