Peb Cov Ntaub Ntawv Ntawm Nivolumab Ntxiv Ipilimumab Therapy hauv Hemodialysis Cov Neeg Mob Nrog Metastatic Raum Cell Carcinoma
Apr 10, 2023
Abstract.
Keeb kwm: Txawm hais tias kev sim CheckMate 214 tau lees paub qhov ua tau zoo ntawm nivolumab-ipilimumab kev sib xyaw ua ke hauv kev kho mob siab lossis metastatic lub raum cell carcinoma (mRCC), nws txoj kev nyab xeeb thiab kev ua tau zoo hauv cov neeg mob uas muaj kab mob hauv lub raum kawg (ESRD) ntawm hemodialysis tseem tsis tau tshawb nrhiav. Case Report: Txhua tus neeg mob yog txiv neej thiab tau txais kev kho mob mRCC nrog ib feem nephrectomy lossis nephrectomy. Lawv muaj ESRD thiab tab tom kho mob haemodialysis. Cov neeg mob 1 thiab 2 tau pom cov qog nqaij hlav qog thiab lub ntsws metastases tom qab pib phais thiab tau txais kev kho nivolumab-ipilimumab.
Case 1 muaj qib 3 adrenal tsis txaus tom qab plaub chav kawm, uas tau tswj hwm nrog steroids. Case 2 tsis tau ntsib cov xwm txheej phem. Ob leeg tau tswj tau zoo nrog ua tiav (CR) lossis ib nrab teb (PR). Case 3 raug kev txom nyem hauv zos tom qab nephrectomy thiab tau txais kev kho ua ke. Qib 3 adrenal insufficiency tau tshwm sim tom qab peb chav kawm, thiab cov qog loj tsis hloov pauv zoo kawg li. Cov ntsiab lus: Nivolumab- ipilimumab kev sib xyaw ua ke tuaj yeem kho tau zoo mRCC cov neeg mob nrog ESRD tab tom muaj hemodialysis.
Kev kho mob ntawm metastatic lub raum cell carcinoma (mRCC) tau hloov pauv loj nrog kev tuaj txog ntawm cov tshuaj tiv thaiv kab mob tiv thaiv kab mob (ICIs). Rau cov neeg mob uas muaj kev pheej hmoo nruab nrab- thiab tsis zoo raws li International Metastatic RCC Database Consortium (IMDC) (1), nivolumab-ipilimumab kev sib xyaw ua ke muab cov txiaj ntsig muaj sia nyob (OS) ntau dua li sunitinib raws li qhia hauv CheckMate 214 sim (2) . Txawm li cas los xij, qhov kev sim tshuaj no tsis suav nrog cov neeg mob uas muaj ESRD tab tom muaj hemodialysis. Qhov xwm txheej ntawm RCC hauv cov neeg mob hemodialysis yog siab dua nyob rau hauv cov pej xeem (3). Tsis tas li ntawd, cov neeg mob nrog mRCC feem ntau ntsib hauv kev kho mob tiag tiag hauv ntiaj teb. Txawm li cas los xij, muaj qhov tsis muaj cov tswv yim kho mob rau mRCC cov neeg mob uas tau mob haemodialysis.
Ntawm no, peb tshaj tawm cov kev tshawb pom los ntawm peb tus neeg mob nrog mRCC tab tom kho hemodialysis kho nrog nivolumab- ipilimumab kev sib xyaw ua ke.
Raws li kab mob hauv lub raum loj tuaj, cov tsos mob hauv qab no yuav tshwm sim. xeev siab thiab ntuav, mob pob qij txha, tsis qab los noj mov, o ko taw thiab pob taws, tawv nqaij qhuav, khaus, ua tsis taus pa, insomnia, tso zis ntau dhau lossis tsawg dhau. Cov tsos mob no feem ntau tshwm sim tom qab theem, txawm tias lawv tuaj yeem tshwm sim hauv lwm yam kab mob. Hauv peb qhov kev tshawb fawb, peb pom tias Cistanche tuaj yeem kho mob raum mob. Cistanche muaj ntau yam khoom xyaw, xws li atractylide, Lycium, adenosine, adenine, deoxyadenosine, thiab lwm yam. Cov khoom xyaw no tuaj yeem tswj hwm lub cev tsis muaj zog, tiv thaiv oxidation, tiv thaiv kab mob thiab lwm yam teebmeem kom ua tiav cov txiaj ntsig ntawm kev kho mob raum mob. .
Case Report
Cov yam ntxwv thiab cov txiaj ntsig kev kho mob ntawm peb tus neeg mob tau sau tseg hauv Table I.
Case 1. Ib tug txiv neej muaj hnub nyoog 70- xyoo tau kuaj pom muaj kab mob raum sab xis thaum kuaj lub plab ultrasound thiab raug xa mus rau peb lub tsev kho mob rau kev soj ntsuam ntxiv. Nws muaj theem 4 mob raum mob (CKD) vim lub raum sclerosis. Txhim kho kev suav tomography (CT) qhia qhov tsis txaus ntseeg RCC nrog txoj kab uas hla ntawm 55 mm nyob rau hauv tus ncej ntawm lub raum sab xis. Nws tau dhau los ua tus neeg hlau pab ib nrab nephrectomy thaum Lub Yim Hli 2018. Cov kev tshawb fawb pom tau pom tseeb ntawm cell RCC, pT1b, thiab qhov kev phais tsis zoo. Kev ua raws CT thaum lub Cuaj Hlis 2019 tau pom cov kab mob metastasis ntawm daim tawv nqaij tom qab thiab, tom qab ntawd, metastasectomy tau ua. Kev kuaj mob pathological yog metastatic RCC. Paraaortic lymph node (LN) metastasis tshwm sim thaum lub Kaum Ob Hlis 2019, thiab lub ntsws metastasis tau pom nyob rau lub Ob Hlis 2020. Nws lub raum ua haujlwm tsis zoo, thiab hemodialysis tau pib thaum lub Plaub Hlis 2020.
Vim qhov loj LN thiab mob ntsws metastases, nws tau kho nrog nivolumab (240 mg) ntxiv rau kev kho ipilimumab (1 mg / kg) txhua 3 lub lis piam rau IMDC intermediate risk mRCC thaum lub Tsib Hlis 2020. Tom qab 4 chav kawm ntawm nivolumab-ipilimumab therapy, LN (Daim duab 1A) thiab mob ntsws tau pom CR.
Tom qab ntawd, raws li Txoj Cai Lij Choj Cov Lus Qhia rau Cov Txheej Txheem Tsis Zoo (CTCAE) version 5.0 qib 3 hauv nruab nrab adrenal tsis txaus, uas yog ib qho kev tiv thaiv kab mob tsis zoo (irAE), tau tshwm sim. Adrenal insufficiency tau tswj los ntawm qhov ncauj steroids. Nws raug kho nrog nivolumab (480 mg) txhua 4 lub lis piam. Nws pheej raug kev txom nyem adrenal insufficiency vim yog kab mob urinary ib ntsuj av. Yog li ntawd, txoj kev kho nivolumab raug txiav tawm. Txawm li cas los xij, tus kab mob tseem nyob hauv kev tswj hwm, thiab nws cov xwm txheej CR tseem nyob tau xya lub hlis tom qab tso tseg nivolumab.
Case 2. Ib tug txiv neej muaj hnub nyoog 63- xyoo raug xa mus rau peb lub tsev kho mob rau ob sab raum qog kuaj pom siv CT li niaj zaus. Nws tau raug kho hemodialysis rau ESRD vim yog mob glomerulonephritis txij li xyoo 1994. Ib sab laug laparoscopic nephrectomy tau ua thaum lub Plaub Hlis 2011, thiab txoj cai nephrectomy tau ua nyob rau lub Rau Hli 2011. Pathological tshawb pom pom papillary RCC (pT1a) ntawm sab laug (thiab pom tseeb. pT1a) ntawm sab xis; ob qho tib si phais cov npoo tsis zoo.
Tom qab kev phais, tus neeg mob tau tso tseg kev mus ntsib tsev kho mob. Thaum lub Cuaj Hlis 2020, nws tau mus xyuas peb lub tsev kho mob nrog lub ntsws thiab LN metastases kuaj pom ntawm CT ntawm lub tsev kho mob kho mob ntshav qab zib. Nws raug kho nrog nivolumab (240 mg) thiab ipilimumab (1 mg / kg) txhua 3 lub lis piam rau IMDC intermediate risk mRCC. Lub ntsws thiab LN metastases txo qhov loj me (PR) yam tsis muaj qhov tshwm sim tsis zoo (Daim duab 1B). Tom qab 4 chav kawm ntawm kev sib xyaw ua ke, kev kho nivolumab tau pib txhua 4 lub lis piam. Txog tam sim no, nws tau txais tsib chav kawm ntawm nivolumab. Nws cov qog loj hlob tseem tswj tau nrog PR raws li txoj cai, thiab tsis muaj cov xwm txheej tsis zoo tau raug sau tseg txog thaum sau tsab ntawv ceeb toom no.
Case 3. Ib tug txiv neej muaj hnub nyoog 40- xyoo tau mus kho hemodialysis rau lub raum theem kawg (ESRD), uas nws aetiology tsis paub, txij li xyoo 2008. Nws tau raug laparoscopic nephrectomy rau sab laug raum cystic qog ntawm lwm lub tsev kho mob Xyoo 2018, thiab lub raum cyst tau tawg thaum lub sijhawm phais. Kev kuaj mob pathological yog qhov tseeb ntawm tes RCC (pT1a), thiab cov npoo phais tsis zoo. Kev soj ntsuam CT nyob rau lub Kaum Ob Hlis 2019 tau nthuav tawm cov ntaub so ntswg mos nyob rau sab laug retroperitoneal qhov chaw.
Cov qog no loj tuaj thaum Lub Ib Hlis 2021, thiab nws raug xa mus rau peb lub tsev kho mob kom kho. Nws tau pib ntawm nivolumab (240 mg) thiab ipilimumab (1 mg / kg) txhua 3 lub lis piam rau IMDC intermediate risk mRCC. Tom qab peb chav kawm ntawm kev kho mob sib xyaw ua ke, nws tau txais mus rau chav kho mob xwm txheej ceev vim kub taub hau thiab qaug zog. Qib 3 hauv nruab nrab adrenal tsis txaus tau kuaj pom thaum kuaj ntxiv, thiab tus neeg mob tau txais kev kho mob steroid. Qhov loj ntawm cov qog nqaij hlav hauv zos tsis hloov pauv loj, qhia tias muaj kab mob ruaj khov (SD). Tom qab tswj cov adrenal tsis txaus siv cov tshuaj steroids, peb pib nivolumab monotherapy (480 mg / 4 lub lis piam). Nws raug kho nrog peb chav kawm ntawm nivolumab thiab tau txais SD yam tsis muaj AEs ntxiv.
Kev sib tham
Lub CheckMate 214 mus sib hais hauv 2018 tau pom qhov ua tau zoo ntawm kev kho thawj kab nrog nivolumab- ipilimumab kev sib xyaw ua ke rau kev kho mob siab lossis metastatic ntshiab cell RCC. Kev sib xyaw ua ke kuj tseem tuaj yeem pab tau rau qhov tsis meej ntawm tes RCC (4), txawm tias mob plawv metastases (5). Hauv qhov sib piv, kev sib xyaw ua ke rau papillary RCC muaj tus nqi siab ntawm cov kab mob loj zuj zus (PD) thiab tsis muaj kev vam meej tsis muaj sia nyob ntau dua li ntawm cov cell RCC (6). Txawm li cas los xij, ob qho kev tshawb fawb tsis suav nrog cov neeg mob hemodialysis. Yog li, tsis muaj lub tswv yim kho mob rau mRCC cov neeg mob nrog ESRD tab tom ua rau haemodialysis.
Muaj ntau cov ntaub ntawv qhia txog ESRD cov neeg mob nrog mRCC kho siv ICIs. Ib tug txiv neej muaj hnub nyoog 68- xyoo nrog mRCC tau txais hemodialysis rau 20 xyoo tau tshaj tawm tias muaj tus kab mob tswj tau nrog kev siv ntev ntev ntawm nivolumab yam tsis muaj kev tiv thaiv kab mob tiv thaiv kab mob (irAEs) tom qab sunitinib tau suav tias tsis muaj txiaj ntsig (7). Hauv lwm qhov xwm txheej, ib tug txiv neej muaj hnub nyoog 77- xyoo nrog mRCC tab tom kho mob haemodialysis, nivolumab tau siv los ua txoj kab plaub. Nws raug mob ua pa tsis ua hauj lwm ob lub lis piam tom qab pib nivolumab thiab xav tau intubation. Nws cov ntaub ntawv raug suav hais tias yog qog pseudoprogression, thiab nws tus mob tau txhim kho nrog tshuaj tua kab mob thiab diuresis, tso cai rau extubation tom qab 2 hnub. Yim lub hlis tom qab pib nivolumab, tus neeg mob tus mob cancer tau txais PR (8). Cavalcante et al. tshaj tawm ob kis ntawm cov neeg mob hemodialysis nrog metastatic melanoma kho siv ipilimumab (9).
Txawm hais tias qib 1 khaus tshwm sim, ipilimumab txoj kev kho tau pab ua tiav PR xwm txheej hauv thawj kis, thiab lwm qhov ua tiav CR xwm txheej nrog qib 3 bullous pemphigoid. Nws tau hais tias irAEs tau cuam tshuam nrog kev kwv yees ntawm cov neeg mob nrog mRCC-kho ICIs. Ntxiv mus, cov neeg mob nrog irAEs tau ntev OS thiab tsis muaj kev vam meej tshaj li cov uas tsis muaj (10).
Hauv peb qhov xwm txheej, cov qog tau tswj tau zoo hauv txhua tus neeg mob nrog CR, PR, lossis SD. Vim tias peb cov xwm txheej tau pom tseeb ntawm tes lossis papillary RCC, qhov ua tau zoo ntawm kev sib xyaw ua ke rau cov neeg mob uas kis tau tus kab mob cystic cuam tshuam nrog RCC, uas tshwm sim hauv cov neeg mob hemodialysis ib yam nkaus, tsis paub meej. Ntxiv mus, peb yuav tsum xav txog qhov chaw tshwj xeeb cov lus teb rau nivolumab yuav txawv nyob ntawm seb lub cev uas tau metastasized (11).
Txawm li cas los xij, hais txog cov xwm txheej tsis zoo, ob ntawm peb tus neeg mob raug kev txom nyem qib 3 hauv nruab nrab adrenal tsis txaus, uas tswj tau siv steroid therapy. Lub adrenal tsis txaus rov tshwm sim hauv thawj tus neeg mob vim yog kis kab mob.
Kev tshuaj xyuas zoo ntawm cov ntaub ntawv pom tau tias cov neeg mob tau txais kev sib xyaw ua ke ICIs muaj qhov tshwm sim ntawm adrenal tsis txaus ntau dua li cov uas tau txais ICI monotherapy (12-14). Txawm li cas los xij, qhov kev tshuaj xyuas no tsis tau tham txog cov xwm txheej ntawm cov neeg mob hemodialysis. Ntau tus neeg mob uas muaj qhov tsis txaus siab ntawm lub hauv nruab nrab adrenal tsis txaus los ntawm ipilimumab tau tshaj tawm tias yuav tsum tau txuas ntxiv kev kho mob steroid vim qhov tsis txaus ntawm lub hauv nruab nrab adrenal tsis txaus (15). Cov neeg mob nrog ESRD tuaj yeem muaj kev kis tus kabmob ntau dua li cov pej xeem vim tias muaj kev tiv thaiv kab mob tsis txaus (16), thiab cov tshuaj steroids tuaj yeem ua rau muaj kev pheej hmoo kis mob ntxiv (17). Xav txog cov kev soj ntsuam no, cov neeg mob hemodialysis muaj qhov pheej hmoo ntawm kev kis kab mob thaum siv tshuaj steroids.
Raws li peb cov ntaub ntawv tshawb pom, kev kis kab mob tau xav tias ua rau muaj tus txheeb ze adrenal insufficiency, zoo li hauv peb thawj kis. Hauv cov neeg mob uas tau txais hemodialysis thiab tau txais kev sib xyaw ua ke ICIs, kev kis kab mob lossis kev ntxhov siab tuaj yeem ua rau tus txheeb ze adrenal tsis txaus. Txawm li cas los xij, kev sib piv AE hauv cov neeg mob hemodialysis tseem nyuaj vim muaj cov ntaub ntawv qhia tsawg tsawg.
Cov neeg mob hemodialysis tau txais cov tshuaj steroids vim yog irAEs yuav tsum tau ua tib zoo ua raws. nivolumab-ipilimumab ua ke kev kho mob rau mRCC cov neeg mob nrog ESRD tuaj yeem pab tswj tus kab mob zoo.
Xaus
Peb tau tshaj tawm cov xwm txheej ntawm peb tus neeg mob nrog mRCC tab tom kho hemodialysis kho siv nivolumab-ipilimumab kev sib xyaw ua ke. Peb xav tias kev tshawb pom ntxov ntawm irAEs thiab kev kho kom raug yog qhov tseem ceeb, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob hemodialysis kho nrog kev kho ua ke. nivolumab- ipilimumab kev sib xyaw ua ke tuaj yeem suav hais tias ua tau zoo txawm tias cov neeg mob hemodialysis nrog mRCC.
Kev tsis sib haum xeeb
Txhua tus kws sau ntawv tsis muaj qhov tsis sib haum xeeb los tshaj tawm txog qhov kev tshawb fawb no.
Cov kws sau ntawv koom tes
YK sau phau ntawv no thiab muab ib lub rooj thiab daim duab. YK, KY, JI, TK, HI, KT thiab TT tau saib xyuas cov neeg mob thiab muab kev kho ua ke. Txhua tus kws sau ntawv tau nyeem thiab pom zoo cov ntawv sau kawg.
Cov ntaub ntawv
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YUKI KOBARI 1, KAZUHIKO YOSHIDA1, JUNPEI IIZUKA1, TSUNENORI KONDO2, HIDEKI ISHIDA1, KAZUNARI TANABE1 thiab TOSHIO TAKAGI 1.
1 Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Nyiv; 2 Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Nyiv.
For more information:1950477648nn@gmail.com
