帕博利珠单抗联合伊匹木单抗导致结肠癌患者免疫性脑炎的病例报告

A case report of immune encephalitis caused by pembrolizumab and ipilimumab in a colon cancer patient

摘要:

在肿瘤治疗过程中，免疫检查点抑制剂（ICI）导致的免疫性脑炎在免疫相关不良事件（irAE）中占比较低，而一旦发生，将严重影响患者生存。本文报道1例结肠癌患者使用帕博利珠单抗联合伊匹木单抗治疗后，第3天即出现反应迟钝、口齿欠清等神经系统症状，经一系列检查后考虑免疫性脑炎，给予甲泼尼龙2 mg·kg^-1·d^-1治疗，14 d后病情得到改善，随后甲泼尼龙逐渐减量，直至停药，患者相关检查结果及症状均恢复正常。ICIs相关神经系统不良反应的早期诊断和治疗对患者预后具有重要意义，本病例对研究PD-1抑制剂和CTLA-4抑制剂所致免疫性脑炎及其治疗方案的制定具有重要参考价值。

Abstract:

In the course of anti-tumor therapy, immune encephalitis caused by immune checkpoint inhibitors (ICI) accounts for a relatively low proportion of immune-related adverse events (irAE), but once it occurs, it will seriously affect the survival of patients. This article reported a colon cancer patient who was treated with pembrolizumab combined with ipilimumab and developed neurological symptoms such as slow reaction and slurred speech on the 3rd day of treatment. After a series of examinations, immune encephalitis was considered, and methylprednisolone was administered at a dose of 2 mg·kg^-1·d^-1. The patient's condition improved after 14 days of treatment, and methylprednisolone was gradually tapered off until it was discontinued. The patient's relevant examination results and symptoms have returned to normal. Early diagnosis and treatment of immune checkpoint inhibitor-related neurological adverse reactions are of great importance to the prognosis of patients. This report is of great significance for the study of immune encephalitis caused by PD-1 inhibitors and CTLA-4 inhibitors and the design of treatment regimens for this side effect.