Pozdní nástup plicní a srdeční toxicity u pacienta léčeného checkpoint inhibitorem v monoterapii

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Autoři: S. Okauchi ¹; Y. Sasatani ¹; H. Yamada ²; H. Satoh ¹
Působiště autorů: Division of Respiratory Medicine, University of Tsukuba, Mito Medical Center – Mito Kyodo General Hospital, Mito, Ibaraki, Japan ¹; Division of Respiratory Medicine, University of Tsukuba, Hitachinaka Medical Center, Hitachinaka, Ibaraki, Japan ²
Vyšlo v časopise: Klin Onkol 2022; 35(2): 150-154
Kategorie: Kazuistiky
doi: https://doi.org/10.48095/ccko2022150

Souhrn

Východiska: Checkpoint inhibitory (immune checkpoint inhibitors –⁠ IPI) mohou vyvolat nežádoucí účinky (immune-related adverse events –⁠ irAE) v orgánech celého těla. Z irAE je nejvýznamnější intersticiální plicní nemoc (interstitial lung disease –⁠ ILD) vyvolaná IPI, která může ohrožovat život. Neméně závažné jsou srdeční irAE vyvolané IPI, které v poslední době vzbuzují pozornost. IrAE obyvkle vznikají během několika měsíců po zahájení léčby IPI, ale některé z nich se vyskytují po delší době. Případ: U 60letého muže s dlaždicobuněčným karcinomem se vyskytla ILD vyvolaná IPI za déle než 2 roky od zahájení terapie. Několik měsíců po zlepšení ILD vyvolané IPI se u tohoto pacienta projevilo srdeční selhání, o kterém se předpokládalo, že je důsledkem narušení ejekce. Ke zlepšení obou typů irAE došlo bez podání kortikosteroidů. Závěr: I když jsou tyto irAE vzácné, mohou se projevit i po dlouhé dobe od zahájení léčby. Pneumologové by si tudíž na irAE s pozdním nástupem měli dát pozor.

Klíčová slova:

karcinom plic – pozdní nástup – plicní toxicita – srdeční toxicita – nežádoucí účinek na imunitní systém – monoterapie checkpoint inhibitory

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