随着免疫检查点抑制剂正在扩展用于妇科恶性肿瘤,罕见的免疫相关不良事件更常见.在这里,我们描述了一位63岁的IIIB期错配修复缺陷子宫腺癌,他接受了六个周期的卡铂和紫杉醇治疗,部分反应但疾病持续存在。然后,她开始使用单一药物pembrolizumab。经过六个周期的pembrolizumab,她出现了双侧视力变化,并被诊断为后巩膜炎。Pembrolizumab被关押,她接受了口服泼尼松治疗,症状迅速缓解。泼尼松完成后一个月,再次报告了视力变化,她在更长的口服泼尼松疗程中重新开始.然后,她接受了明确的手术治疗,包括全腹腔镜子宫切除术和双侧附件卵巢切除术。最终病理为子宫内膜良性增生。她完成了类固醇课程,没有任何症状。鉴于她的完全病理反应,她随后被纳入监测,目前没有疾病证据。及时识别和治疗这种罕见的免疫相关不良事件导致预防潜在的永久性事件,使人衰弱的结果。
As Immune checkpoint inhibitors are being expanded for use in gynecologic malignancies, rare immune-related adverse events are more frequently being reported. Here we describe a 63-year-old with Stage IIIB mismatch repair deficient uterine adenocarcinoma who underwent six cycles of carboplatin and paclitaxel with partial response but persistent disease. She was then started on single agent pembrolizumab. After six cycles of pembrolizumab, she developed bilateral vision changes and was diagnosed with posterior scleritis. Pembrolizumab was held and she was treated with oral prednisone, with rapid resolution of symptoms. One month after completion of prednisone, vision changes were again reported and she was restarted on a longer oral prednisone course. She then underwent definitive surgical management consisting of a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy, with final pathology of benign endometrial hyperplasia. She has completed her steroid course without any symptoms. Given her complete pathologic response, she was subsequently placed into surveillance and is currently without evidence of disease. Prompt recognition and treatment of this rare immune-related adverse event led to the prevention of potential permanent, debilitating outcomes.