Guillain-Barré Syndrome Developed as a Neurological Immune-related Adverse Event After Response to Combination Chemo-immunotherapy
- 20 February 2021
- journal article
- Published by Japan Lung Cancer Society in Haigan
- Vol. 61 (1), 24-29
- https://doi.org/10.2482/haigan.61.24
Abstract
背景.免疫チェックポイント阻害薬(immune checkpoint inhibitors:ICI)は非小細胞肺癌の標準治療で,様々な免疫関連有害事象の報告がある.免疫関連神経障害(neurological immune-related adverse event:nAE)は稀で,報告例は少ない.症例.64歳男性.肺腺癌cT3N3M0,Stage IIICと診断し,初回治療でシスプラチン,ペメトレキセドおよびペムブロリズマブを開始した.最良効果は部分奏効で,ペメトレキセドおよびペムブロリズマブで維持療法を継続した.6サイクル施行後,胸部X線写真で左上肺野に浸潤影を認め,免疫関連肺障害を疑った.休薬と対症療法では肺陰影は増悪し,プレドニゾロン(prednisolone:PSL)の加療開始で浸潤影は改善し,PSLを漸減した.PSL漸減中に四肢脱力,感覚障害が出現しnAEを疑った.精査でギランバレー症候群と診断した.ステロイドパルス療法で感覚障害は軽快も,四肢脱力は残存した.大量免疫グロブリン療法施行で四肢脱力も改善した.結論.nAEはICI投与後早期に多いが,投与早期以降も発症の可能性があり注意を要する.This publication has 12 references indexed in Scilit:
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