尽管在过去十年中,癌症治疗策略的疗效一直在稳步提高,此类治疗后的不良事件概况也变得越来越复杂.本报告描述了一名67岁的男性残胃癌伴肝浸润的病例。患者接受奥沙利铂和卡培他滨(CAPEOX方案)化疗,联合程序性细胞死亡蛋白-1(PD-1)抑制剂tislelizumab。治疗后,病人发冷,高烧面部潮红,接着是震惊。相关检查结果显示严重的多器官损伤,以及IL-6和降钙素原(PCT)水平显着升高。最初,患者被诊断为与tislelizumab引起的细胞因子释放综合征相关的免疫相关不良事件(irAEs)或严重的细菌感染.然而,当停止tislelizumab治疗并重新应用CAPEOX化疗方案时,类似症状复发。筛选后,最终确定奥沙利铂引起的严重超敏反应(HSR)是这些症状的根本原因.然后进行了文献综述,发现严重的奥沙利铂相关的HSR很少见,使目前的情况变得非典型。本案没有常见的HSR症状,如皮肤和呼吸道症状。然而,病人患有严重的多器官损伤,奥沙利铂化疗联合PD-1抑制剂时误诊为irAE。此外,这种明显严重的奥沙利铂相关HSR导致PCT水平显着增加,被误诊为严重的细菌感染,并阻止了糖皮质激素的使用。这个,反过来,加重了这个病人的伤害.
Although the efficacy of treatment strategies for cancer have been improving steadily over the past decade, the adverse event profile following such treatments has also become increasingly complex. The present report described the
case of a 67-year-old male patient with gastric stump carcinoma with liver invasion. The patient was treated with oxaliplatin and capecitabine (CAPEOX regimen) chemotherapy, combined with the programmed cell death protein-1 (PD-1) inhibitor tislelizumab. Following treatment, the patient suffered from chills, high fever and facial flushing, followed by shock. Relevant examination results revealed severe multiple organ damage, as well as a significant elevation in IL-6 and procalcitonin (PCT) levels. Initially, the patient was diagnosed with either immune-related adverse events (irAEs) associated with cytokine release syndrome caused by tislelizumab or severe bacterial infection. However, when tislelizumab treatment was stopped and the CAPEOX chemotherapy regimen was reapplied, similar symptoms recurred. Following screening, it was finally determined that severe hypersensitivity reaction (HSR) caused by oxaliplatin was the cause underlying these symptoms. A literature review was then performed, which found that severe oxaliplatin-related HSR is rare, rendering the present
case atypical. The present
case exhibited no common HSR symptoms, such as cutaneous and respiratory symptoms. However, the patient suffered from serious multiple organ damage, which was misdiagnosed as irAE when oxaliplatin chemotherapy combined with the PD-1 inhibitor was administered. In addition, this apparent severe oxaliplatin-related HSR caused a significant increase in PCT levels, which was misdiagnosed as severe bacterial infection and prevented the use of glucocorticoids. This, in turn, aggravated the damage in this patient.