口腔癌病人接受細胞程式死亡蛋白-1抑制劑所引發的類天疱瘡副作用

Bullous Pemphigoid Associated with Programmed Cell Death Protein 1 Inhibitor for Oral Cavity Cancer

10.6320/FJM.202409_28(5).0004

謝春燕(Chun-Yen Hsieh)；謝合原(He-Yuan Hsieh)

類天疱瘡 ； 免疫檢查點抑制劑 ； 吉速達 ； 保疾伏 ； 頭頸部鱗狀細胞癌 ； bullous pemphigoid ； checkpoint inhibitor ； nivolumab ； PD1 ； pembrolizumab

台灣醫學

28卷5期（2024 / 09 / 25）

537 - 541

繁體中文;英文

本病例報告報導了1名67歲男性，患有反覆復發的頭頸部癌症病史，在接受免疫檢查點抑制劑治療期間發展出了類天疱瘡（bullous pemphigoid），這是一種嚴重的皮膚免疫相關不良事件（immune-related adverse event, irAE）。該患者曾有頭頸部鱗狀細胞癌的病史，在接受免疫檢查點抑制劑（pembrolizumab and nivolumab）之前進行過多種治療，包括化療及放射線治療。儘管腫瘤對免疫療法的療效良好，但該患者在臉部、頸部、軀幹和四肢上出現了廣泛的紅斑斑塊，並伴有糜爛性傷口。皮膚病灶的病理切片，確認了類天疱瘡的診斷，直接性螢光切片檢查顯示出C3和IgG在真皮表皮交界處的沉積。儘管在出現類天疱瘡後停止了免疫療法，但該患者的腫瘤治療效果仍持續有效。本篇報導強調了該嚴重皮膚副作用的重要性，它們可能對治療產生中斷，可能影響病人的生活品質，因此我們需要個人化治療及處理相關的治療及處理策略。儘管患者的癌症治療對免疫療法產生了良好的治療效果，但類天疱瘡的發生與癌症治療效果之間的確切關聯性仍不確定，這需要更進一步的研究來驗證。

This case report discusses a 67-year-old man with recurrent head and neck cancer who developed bullous pemphigoid, a severe cutaneous immune-related adverse event (irAE), during the treatment with immune checkpoint inhibitors. The patient had a history of squamous cell carcinoma of head and neck and underwent various treatments, including chemotherapy and radiotherapy, before receiving programmed cell death protein 1 inhibitors (pembrolizumab and nivolumab). While the immunotherapy led to a favorable response against the cancer, the patient developed widespread erythematous plaques with erosive wounds on face, neck, trunk and four limbs. Biopsy confirmed bullous pemphigoid, with immunofluorescence showing dermoepidermal junction deposits of C3 and IgG. Although the immunotherapy was discontinued after the development of bullous pemphigoid, the patient's treatment efficacy was sustained. The report underscores the challenge of managing severe cutaneous irAEs, their impact on treatment continuity, and the need for tailored strategies. Although the patient's cancer responded well to immunotherapy, the exact link between irAEs and treatment efficacy remains uncertain, warranting further investigation.