JAMA Neurol:PD-1单抗治疗相关神经系统并发症及其处置方法

2017-09-07 zhangfan MedSci原创

研究发现,神经系统不良反应与抗PD-1治疗相关,表现出多种表型以及频繁的神经并发症,尽管上述并发症较为罕见,但PD-1单抗疗法的并发症频率显著高于其他肿瘤疗法,且发作时间不可预知,进展迅速且致命。研究认为出现PD-1治疗相关的神经系统并发症后应立即终止治疗,必要时采取免疫应激治疗

统计发现在接受PD-1单抗治疗实体瘤的患者中,4.2%患者存在神经系统并发症。近日研究人员对PD-1治疗相关的神经系统并发症的发病频率、临床谱和最佳治疗方法就行了分析。

研究人员考察了2014-2016年间,PD-1单抗治疗后相关的不良事件报告数据,治疗后12个月内的所有神经系统相关事件均收录在内,但直接因转移性疾病或其他癌症相关治疗而导致神经系统并发症患者被排除在外。

研究发现,在347名接受PD-1单抗治疗的患者中,10人(2.9%)发生亚急性神经系统并发症,其中3人接受nivolumab。患者8男2女,平均年龄71岁。在疗程平均持续5.5轮后出现神经系统症状,包括肌病(n=2),外周神经病变(n=4)、小脑共济失调(n=1),自身免疫糖尿病视网膜病变(n=1),双侧核间性眼肌麻痹(n=1)以及头痛(n= 1)。外周神经病变包括轴突和脱髓鞘多发性神经根神经病(n = 2),长度依赖性神经病变(n= 1)和不对称的血管炎性周围神经病(n = 1)。严重症状持续时间1天到3个月。平均的预后得分为2.5分,表明存在中度的残疾。5名患者出现其他全身性免疫介导并发症,包括甲状腺功能减退症(n = 3),结肠炎(n=2),肝炎(n= 1)。所有患者均终止了PD-1治疗,并发症治疗方法包括:糖皮质激素(n=7),静脉注射免疫球蛋白(n=3)以及血浆置换(n = 1)。9人治疗后症状改善,平均预后得分为2分,1名患者死于严重的坏死性肌病。

研究发现,神经系统不良反应与抗PD-1治疗相关,表现出多种表型以及频繁的神经并发症,尽管上述并发症较为罕见,但PD-1单抗疗法的并发症频率显著高于其他肿瘤疗法,且发作时间不可预知,进展迅速且致命。研究认为出现PD-1治疗相关的神经系统并发症后应立即终止治疗,必要时采取免疫应激治疗。

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    2018-01-07 yinhl1978
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    2017-12-08 丁鹏鹏
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    2017-09-08 虈亣靌

    临床医药学的一大进步啊

    0

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    2017-09-08 jet747

    学习了.谢谢

    0

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    2017-09-08 luominglian113

    学习了.谢谢分享

    0

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