- 期刊
A Novel Experience of Nivolumab-Associated Toxic Epidermal Necrolysis in a Patient with Metastatic Non-Small Cell Lung Cancer in Taiwan--A Case Report
免疫療法治療非小細胞癌造成中毒性表皮壞死性症候群－個案報告
摘要
Background: Immune checkpoint inhibitors are revolutionary therapeutic agents for advanced malignancies. However, severe cutaneous reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients treated with these drugs. Aim and Objective: To present the rare case of nivolumab-associated TEN in a patient with metastatic non-small cell lung cancer in Taiwan. Materials and methods: We report a case of nivolumab-associated TEN in a patient with metastatic non-small cell lung cancer. The three main strategies used for patient care included fluid therapy, early continuous venovenous hemodialysis, and application of silver-containing dressing. Results: Our strategies were successful. The mucocutaneous wound eruption gradually improved and healed, the steroid dose was tapered, and the patient’s condition initially stabilized. However, the patient eventually succumbed to his terminal condition due to systemic deterioration and poor prognosis. Conclusion: Immune checkpoint inhibitors have revolutionized the field of oncology. However, with their emergence, the incidence of cutaneous adverse events is likely to increase. Therefore, early diagnosis and management of associated skin toxicities are important.
並列摘要
背景：免疫檢查點抑製劑對於晚期的惡性腫瘤是一種革命性治療方法。然而，有些報告指出，少數人接受這些藥物治療的患者會出現藥物不良反應反應，甚至是嚴重的皮膚不良反應，例如史蒂夫強森綜合徵和中毒性表皮壞死溶解症。目的及目標：介紹罕見案例使用保疾伏，納武單抗相關免疫療法製劑，治療轉移性非小細胞肺癌患者造成嚴重皮膚不良反應，中毒性表皮壞死溶解症的病例。材料及方法：我們報告了一名64歲男性使用保疾伏，納武單抗相關免疫療法製劑，治療轉移性非小細胞肺癌造成嚴重皮膚不良反應，中毒性表皮壞死溶解症。我們治療的主要策略有三個重點。第一、嚴密的體液監測，第二、早期連續靜脈血液透析，以及第三、應用含銀敷料照護傷口。結果：我們的策略取得了令人滿意的結果。皮膚粘膜皮疹的傷口情況逐漸好轉和癒合。類固醇劑量逐漸減量，患者慢慢脫離呼吸器。然而，該患者最終因全身性惡化和多發轉移的晚期肺癌預後不佳而死亡。結論：免疫檢查點抑製劑徹底改變了腫瘤學領域。然而，隨著它們的普及，皮膚不良事件的發生率亦慢慢增加。因此，相關皮膚毒性的早期診斷和處理非常重要。