Primena Nivolumaba kod pacijenta sa mukozalnim melanomom i sistemskim lupusom: prikaz slučaja i pregled literature

  • Aleksandar Popovic Klinika za onkologiju, UKC Niš
  • Ivan Petković University of Nis, Faculty of Medicine, Department of Oncology, Nis, Serbia.
  • Andrija Rančić Gastroenterology and Hepatology Clinic, University Clinical Center Nis, Serbia
  • Aleksandra Dimitrijevic Clinic of Oncology, University Clinical Center Nis, Serbia
  • Vesna Brzacki University of Niš, Faculty of Medicine, Department of Internal medicine Nis, Serbia
  • Andrija Jović 6Clinic of Dermatovenerology, University Clinical Center Nis, Serbia
  • Stefan Stankov Clinic Center for Radiology, University Clinical Center Nis, Serbia
  • Sonja Stojanovic University of Niš, Faculty of Medicine, Department of Internal medicine Nis, Serbia
DOI: https://doi.org/10.5937/afmnai40-40566
Ključne reči: mukozalni melanom, sistemski lupus, inhibitori kontrolnih tačaka, Nivolumab

Sažetak


Sistemski lupus predstavlja multisistemsku bolest koju karakteriše stvaranje antitela, aktivacija komplemenata i nagomilavanje imunskih kompleksa. Različite vrste maligniteta mogu se ćešće, ali i ređe javiti kod pacijenata sa sistemskim lupusom. Mukozalni melanom anorektalne regije je retka forma melanoma. Javlja se predominantno kod žena, i čini oko 1.5% pacijenata sa melanomom. Uvođenje inovativne terapije drastično je izmenilo terapijski ishod kod pacijenata sa melanomom, ali je doveo i do pojave novih neželjenih efekata, kontraindikacija i interakcija sa drugim lekovima.

Inhibitori kontrolnih tačaka imaju ulogu u održavanju imunološke homeostaze. Pacijenti sa autoimunim bolestima često su isključivani iz kliničkih studija zbog bojazni od egzacerbacije autoimmune bolesti i pojave neželjenih efekata visokog stepena. Usled toga, za ovu podgrupu pacijenata ne postoje jasne preporuke. Prevalence autoimunih bolesti u populaciji je visoka (5-10%), te one predstavljaju čest komorbiditet kod onkoloških pacijenata. Uzimajući obzir gore navedeno neophodan je personalizovani pristup koji bi omogućio tretman inhibitorima kontrolnih tačaka na najsigurniji način, uz adekvatnu kontrolu sistemskog lupusa.

Prikazali smo pacijentkinja staru 79 godina sa metastatskim primarnim mukozalnim melanomom anorektalne regije i ranije postavljenom dijagnozom sistemskog lupusa. U trenutku postavljanja dijagnoze melanoma, sistemski lupus bio je u remisiji, sa hidroksihlorokinom kao jedinom terapijom. Započeta je terapija Nivolumabom u standardnim dozama, bez izmene konkomitantne terapije sistemskog lupusa. Nakon prve tri kontrole, i ukupno 12 ciklusa imunoterapije, nije detektovana dalja progresija onkološkog oboljenja, kao ni egzacerbacija sistemskog lupusa i pojava imunoloških neželjenih efekata Nivolumaba.

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Objavljeno
2025/12/19
Broj časopisa
Vol. 40 Br. 4 (2023): Acta facultatis medicae Naissensis
Rubrika
Prikaz slučaja / Case report