PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors (ICIs) have completely changed cancer treatment in the last decade and are now widely used in several cancers. In the era of immunotherapy, oncologists have changed not only the way they evaluate treatment efficacy but also the management of treatment-related adverse events. This new profile of immune adverse events has resulted in an urgent need for a more holistic view of cancer patients and for more collaborations with other organ specialists to optimize patient treatment and support. The anti-programmed death-ligand 1 antibody, avelumab, has been widely used as a maintenance treatment in stage IV urothelial carcinoma since the results from the Javelin 100 bladder trial were published. We report a case of a 75-year-old man with stage IV urothelial carcinoma submitted to first-line platinum-based chemotherapy followed by maintenance avelumab. He achieved a complete bone and pulmonary response 10 months after stopping avelumab, which was suspended due to a serious immune adverse event, an ICI-induced type 1 diabetes mellitus. At present, the patient has an overall survival of 24 months and shows no evidence of disease with a good quality of life 16 months after avelumab suspension. We hypothesized that a late response to avelumab could explain this unexpected outcome.
摘要：
免疫检查点抑制剂（ICI）在过去十年中彻底改变了癌症治疗，现在已广泛用于几种癌症。在免疫疗法时代,肿瘤学家不仅改变了他们评估治疗疗效的方式,而且改变了治疗相关不良事件的管理方式.这种免疫不良事件的新情况导致迫切需要对癌症患者进行更全面的了解，并与其他器官专家进行更多合作，以优化患者的治疗和支持。抗程序性死亡配体1抗体，阿维鲁单抗,自从标枪100膀胱试验的结果发表以来，已被广泛用作IV期尿路上皮癌的维持治疗。我们报告了一例患有IV期尿路上皮癌的75岁男性患者，该患者接受了基于铂的一线化疗，然后维持阿维鲁单抗。停用阿维鲁单抗10个月后，他实现了完全的骨骼和肺部反应，由于严重的免疫不良事件而被暂停，ICI诱导的1型糖尿病。目前,患者的总生存期为24个月,且在阿维鲁单抗混悬液后16个月无疾病迹象,生活质量良好.我们假设对avelumab的晚期反应可以解释这种意外的结果。
