托法替布用于类固醇难治性免疫相关性心肌炎病例分析

Analysis of a case of treatment foRsteroid-refractory immune related myocarditis with tofacitinib

免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)是近年来抗肿瘤治疗的重要药物,能为患者带来显著的生存收益。然而ICIs引起的免疫相关性不良反应不容忽视,特别是ICIs相关性心肌炎,发生率低但致死率高。糖皮质激素是目前治疗ICIs相关性心肌炎的首选及核心方案。在激素治疗过程中,如病情加重,可联合吗替麦考酚酯(mycophenolate mofetil,MMF)、他克莫司、英夫利昔单抗等其中1种药物。阿仑单抗和阿巴西普对于糖皮质激素治疗无效的严重心肌炎患者可能有效,但阿巴西普可能促进肿瘤的生长。本文对1例使用特瑞普利单抗联合西妥昔单抗以及伊立替康抗肿瘤方案出现免疫相关性心肌炎,随即采用糖皮质激素联合人免疫球蛋白治疗失败后,加用口服托法替布,心肌损伤生物标志物显著下降的结肠癌患者进行分析讨论,以期为临床类固醇难治性免疫相关性心肌炎提供新的治疗思路。

Immune checkpoint inhibitors(ICIs)are important ways of anti-tumoRtherapy in recent years,which have demonstrated significant clinical benefits.However,the immune-related adverse events caused by ICIs should not be ignored,especially ICIs-related myocarditis,which is rare but fatal.Glucocorticoids are the first choice and the core treatment foRICIsassociated myocarditis.In the process of hormone therapy,if the condition worsens,one of the drugs such as mycophenolate mofetil(MMF),tacrolimus,and infliximab can be combined.Alemtuzumab and abatacept may be effective foRpatients with severe myocarditis who do not respond to glucocorticoid therapy,but abatacept may promote tumoRgrowth.This papeRanalyzed and discussed a case of immuno-related myocarditis in a colon canceRpatient who was treated with toripalimab combined with cetuximab and irinotecan,oral tofacitinib was added afteRfailure of treatment with glucocorticoid combined with intravenous immunoglobulin,then the biomarkers of myocardial injury decreased significantly.This papeRprovides a new idea foRclinical treatment of steroidrefractory immune related myocarditis.