演題抄録

ポスター

開催概要
開催回
第58回・2020年・京都
 

肺腺癌に対する免疫チェックポイント阻害剤投与に関連した脳症の一例

演題番号 : P-209

[筆頭演者]
大田 隆代:1 
[共同演者]
濱田 征宏:2、上野 周一:2、福岡 正博:1

1:和泉市立総合医療センター・腫瘍内科、2:和泉市立総合医療センター・神経内科

 

Background: Immune checkpoint inhibitors (ICIs) are widely used for malignancies, including non-small cell lung cancer. Neurologic toxicity is one of the immune-related adverse events. Case report: An 84-year-old woman with advanced lung cancer was admitted to our hospital to undergo a course of palliative radiation therapy to improve her right shoulder pain. She was diagnosed with lung adenocarcinoma in the right upper lobe. The cancer stage was cT3N2M1b, cStageIVA. The tumor proportion score of PD-L1 expression in the tissue was 70%. She received ten cycles of pembrolizumab and four cycles of atezolizumab. On day 3, she developed muscle weakness in extremities, and then, she became in a state of coma. After 30 min, she recovered consciousness. Brain magnetic resonance imaging (MRI) showed no space-occupying lesions or hemorrhage. On day 4, she became delirious during the night. On day 5, she tried to lock herself in the bathroom. She was agitated and stayed in the bathroom for 30 min. Two hours later, she became calm down and took quetiapine, following instructions. Radiation therapy was discontinued. On day 9, she had a continuous status of complex partial seizure. The seizure was stopped temporarily by diazepam, but her consciousness was not recovered. Diffusion-weighted image of brain MRI showed high signals in left thalamus and parahippocampus gyrus, indicating seizure or encephalitis. Malignant cells were not found in the spinal tap. EEG demonstrated myoclonus epilepsy. One of the paraneoplastic syndrome-antibodies, anti-recoverin, was +/-. We suspected the epilepsy was associated with ICIs. On day 11, methyl-prednisolone half pulse therapy followed by tapered steroids was administered. On day 18, she gradually regained her consciousness. Conclusions: We report a case of encephalopathy after the administration of two different types of ICIs in lung adenocarcinoma. The patient showed several different neurological clinical conditions.

キーワード

臓器別:肺・縦隔・胸膜

手法別:免疫療法

前へ戻る