PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors such as monoclonal antibodies have been used recently with greater effect for the management of non-small cell lung cancer (NSCLC). Sintilimab, a fully human IgG4 monoclonal antibody is specific for the immune checkpoint protein programmed cell death receptor-1 (PD-1). It is a common medication adopted for treating Hodgkin\'s lymphoma and NSCLC. The adverse effects associated with the use of monoclonal antibodies should be closely monitored and in the current report, the use of sintilimab for treating NSCLC led to skin-associated adverse effects such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Genetic testing showed that genes such as KRAS, CREBBP, NTRK1, RAF1, and TP53 were mutated. Initial visible symptom included the formation of a vesicular rash on the skin that had spread to the upper limbs, chest, and dorsum 1 week after the administration of sintilimab. The patient received anti-inflammatory agents to prevent worsening of the rashes and further infections. When the vesicles in back and limbs enlarged and the neck skin began to desquamate, the patient was diagnosed with Stevens-Johnson syndrome and sintilimab-induced toxic epidermal necrolysis. Toxic epidermal necrolysis was diagnosed via clinical symptoms and physical examination. The patient also reported the symptoms of oral mucositis. As soon as the dose of sintilimab was reduced to 20 mg/day, the skin-associated condition of the patient began to improve. Although the lump in the lungs decreased considerably 45 days after initial administration of sintilimab, the medication was stopped from use as soon as the skin-related symptoms improved after its withdrawal. This report suggests that close monitoring, personal care, and proper use of medications such as sintilimab should be implemented to avoid such rare skin-associated toxicities as an adverse effect.
摘要：
免疫检查点抑制剂如单克隆抗体最近已被用于治疗非小细胞肺癌(NSCLC)具有更大的效果。Sintilimab,完全人IgG4单克隆抗体对免疫检查点蛋白程序性细胞死亡受体-1(PD-1)具有特异性.它是治疗霍奇金淋巴瘤和非小细胞肺癌的常用药物。应密切监测与使用单克隆抗体相关的不良反应，并在当前报告中，使用辛替利玛治疗NSCLC会导致皮肤相关不良反应,如Stevens-Johnson综合征和中毒性表皮坏死松解症.基因检测显示KRAS等基因,CREBBP,NTRK1、RAF1和TP53发生突变。最初的可见症状包括皮肤上形成的水疱性皮疹，并扩散到上肢，胸部，和背部1周后服用sintilimab。患者接受抗炎药以防止皮疹恶化和进一步感染。当背部和四肢的囊泡增大，颈部皮肤开始脱皮时，患者被诊断为Stevens-Johnson综合征和sintilimab诱导的中毒性表皮坏死松解症.通过临床症状和体格检查诊断中毒性表皮坏死松解症。患者还报告了口腔粘膜炎的症状。一旦sintilimab的剂量减少到20毫克/天，患者的皮肤相关状况开始改善。虽然肺部肿块在初次给药后45天明显减少，停药后，一旦皮肤相关症状改善，药物就停止使用。这份报告表明，密切监测，个人护理,和正确使用药物，如sintilimab应实施，以避免这种罕见的皮肤相关的毒性作为不良反应。
