抗程序性细胞死亡蛋白1(PD-1)疗法在治疗具有缺陷错配修复/高微卫星不稳定性(dMMR/MSI-H)转移性结直肠癌(mCRC)的患者中表现出显著疗效。然而,其临床应用充满挑战,并可能导致显著的免疫相关不良事件(ir-AE).在这份报告中,我们提出了一个复杂的病例,mCRC患者的MSI-H和β2M和LRP1B蛋白突变,并发菌血症和肝吸虫感染,谁接受了一线抗PD1治疗。患者对抗PD1治疗表现出阳性反应,即使同时存在抗生素和抗寄生虫干预措施。此外,患者经历了免疫疗法相关的自身免疫性溶血性贫血(ir-AIHA),罕见的血液学ir-AE,后来得到了有效的治疗。免疫疗法代表了肿瘤治疗的关键和高度有效的方法。MMR和MSI状态的基线评估是启动免疫治疗之前的关键步骤。并且在治疗过程中定期进行评估可以促进早期识别任何继发性并发症,能够及时干预并确保最佳治疗结果。总的来说,多学科诊断和治疗算法可以帮助最大限度地提高免疫治疗的治疗效益.
Anti-programmed cell death protein 1 (PD-1) therapy has demonstrated notable efficacy in treating patients with deficient mismatch repair/high microsatellite instability (dMMR/MSI-H) metastatic colorectal cancer (mCRC). However, its clinical application is fraught with challenges and can lead to significant immune-related adverse events (ir-AEs). In this report, we present a complicated case of an mCRC patient with MSI-H and mutations in β2M and LRP1B proteins, complicated by concurrent bacteremia and liver fluke infection, who received first-line anti-PD1 therapy. The patient exhibited a positive response to anti-PD1 treatment, even in the presence of concomitant antibiotic and anti-parasitic interventions. Additionally, the patient experienced immunotherapy-related autoimmune hemolytic anemia (ir-AIHA), a rare hematological ir-AE, which was effectively treated later on. Immunotherapy represents a pivotal and highly effective approach to tumor treatment. Baseline assessment of the MMR and MSI status is a crucial step before initiating immunotherapy, and regular ongoing assessments during the treatment course can facilitate early recognition of any secondary complications, enabling prompt intervention and ensuring optimal therapeutic outcomes. Overall, a multidisciplinary diagnostic and therapeutic algorithm can help maximize the therapeutic benefits of immunotherapy.