Fatální myokarditida po první dávce nivolumabu

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Authors: E. Zomborska ¹; S. Kasperova ²; J. Slopovsky ¹; N. Pazderová ¹; B. Kasperova ³; P. Penz ⁴; O. Nyitrayová ⁵; T. Salek ¹; S. Porsok ¹; B. Mladosievicova ⁶; M. Mego ¹
Authors‘ workplace: National Cancer Institute, Bratislava, Slovak Republic ; 2nd Department of Oncology, Comenius University, Faculty of Medicine and National Cancer Institute, Bratislava, Slovak Republic ¹; 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic ²; Department of Oncohematology, Faculty of Medicine, Comenius University, Slovakia ³; Department of Dia gnostic and Interventional Radiology, National Heart Institute, Bratislava, Slovak Republic ⁴; Biopsy centrum Cytophatos, Bratislava, Slovak Republic ⁵; Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic ⁶
Published in: Klin Onkol 2022; 35(6): 486-492
Category: Case Reports
doi: https://doi.org/10.48095/ccko2022486

Overview

Východiska: Karcinom thymu (thymic carcinoma – TC) je vzácným podtypem malignity thymu epiteliálního původu. Stěžejní součástí léčby TC je chirurgická resekce, zatímco radioterapie a chemoterapie jsou modality, které se používají v adjuvantním nebo paliativním režimu. Checkpoint inhibitory, kam patří protilátky proti receptoru programované buněčné smrti 1 (programmed cell death 1 – PD-1), představují nově vznikající modalitu léčby TC, nicméně jejich podávání může být spojeno s život ohrožující toxicitou. Případ: Prezentujeme případ 59leté ženy s grade III TC, které byla podána neoadjuvantní chemoterapie, po které následoval chirurgický zákrok a následně byla podána adjuvantní radioimunoterapie s checkpoint inhibitorem, nivolumabem. V článku sdělujeme naše zkušenosti s toxicitou podávaného přípravku. Výsledky: Čtrnáct dní po první dávce nivolumabu a 21. den po zahájení radioterapie (v celkové dávce 40 Gy) se u pacientky rozvinula fulminantní myokarditida s následným srdečním selháním. I přes imunosupresivní terapii vysokodávkovými glukokortikoidy a mykofenolát mofetilem a přes intenzivní podpůrnou terapii pacientka během 6 dní od nástupu prvních symptomů zemřela. Závěr: Lékaři by měli mít na paměti tyto extrémně vzácné, avšak potenciálně fatální komplikace imunoterapie.

Klíčová slova:

nivolumab – imunoterapie – checkpoint inhibitory – kardiotoxicita – karcinom thymu

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