中国药物警戒 ›› 2023, Vol. 20 ›› Issue (7): 825-828.
DOI: 10.19803/j.1672-8629.20220552

• 安全与合理用药 • 上一篇    下一篇

阿昔替尼片联合特瑞普利单抗治疗晚期肾癌致视网膜中央动脉阻塞1例分析

王淑伟1, 殷进军1, 王冰2, 宋彩萍3, 杨福俊4   

  1. 1山东大学附属威海市立医院放疗二科,山东 威海 264200；
    2山东大学附属威海市立医院药剂科,山东 威海 264200；
    3山东大学附属威海市立医院眼科,山东 威海 264200；
    4山东大学附属威海市立医院肿瘤综合科,山东 威海 264200
  • 收稿日期:2022-09-21 出版日期:2023-07-15 发布日期:2023-07-14
  • 通讯作者: *杨福俊,男,博士,副主任医师·硕导,肿瘤放射治疗学。E-mail:yangfujun228@163.com
  • 作者简介:王淑伟,女,硕士,主治医师,肿瘤放射治疗学。
  • 基金资助:
    山东省老年医学学会科技攻关计划项目（LKJGG2021W123）

Axitinib tablets combined with toripalimab injection in the treatment of renal cancer-induced central retinal artery occlusion: a case report

WANG Shuwei1, YIN Jinjun1, WANG Bing2, SONG Caiping3, YANG Fujun4   

  1. 1The Second Department of Radiotherapy,Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai Shandong 264200, China;
    2Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai Shandong 264200, China;
    3Department of Ophthalmology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai Shandong 264200, China;
    4Department of Integrative Oncology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai Shandong, 264200, China
  • Received:2022-09-21 Online:2023-07-15 Published:2023-07-14

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摘要： 目的 分析阿昔替尼联合特瑞普利单抗治疗晚期肾癌致视网膜中央动脉阻塞的临床特点及诊治方案。方法 对1例应用阿昔替尼联合特瑞普利单抗治疗晚期肾癌致视网膜中央动脉阻塞的病例进行分析。结果 1例患者因肾癌晚期接受阿昔替尼5 mg,每日2次联合特瑞普利单抗240 mg,静脉滴注,每2周1次,总生存期（OS）超过5年,无进展生存期（PFS）近4年,可见疗效显著。联合治疗2.5年后出现右眼视网膜中央动脉阻塞,颅脑增强MRI、胸部增强CT、颈颅血管、双下肢动静脉、肾血管彩超均未见血栓,D-二聚体0.5 mg·L-1（在正常范围之内）及眼科相关检查排除其他眼部疾病,考虑阿昔替尼所致血栓栓塞不良反应,同时特瑞普利单抗有可能增加血栓栓塞的风险,怀疑加重阿昔替尼不良反应。停用阿昔替尼,给予按摩眼球,噻吗洛尔滴眼液滴眼降眼压,球后注射利多卡因注射液、盐酸消旋山莨菪碱注射液、地塞米松磷酸钠注射液解痉,尿激酶溶栓,同时甲泼尼龙琥珀酸钠30 mg·d-1静脉滴注等治疗效果不佳,患者右眼视力未改善,随诊未出现其他眼部症状。结论 阿昔替尼联合特瑞普利单抗治疗晚期肾癌疗效显著,在联合用药期间,需关注患者的临床症状及影像学特征,警惕可能导致视网膜中央动脉阻塞的风险。

关键词: 阿昔替尼, 特瑞普利单抗, 肾癌, 视网膜中央动脉阻塞, 联合用药, 药品不良反应

Abstract: Objective To analyze the clinical characteristics, diagnosis and treatment of central retinal artery occlusion caused by axitinib combined with toripalimab in the treatment of advanced renal cell carcinoma. Methods One case of central retinal artery occlusion caused by advanced renal cell carcinoma treated with axitinib combined with toripalimab was analyzed. Results A patient with advanced renal cell carcinoma received axitinib 5 mg combined with toripalimab 240 mg, intravenous drip, once every two weeks. The overall survival (OS) was more than 5 years, and the progression-free survival (PFS) was nearly 4 years, suggesting the significant efficacy of this therapy. After 2.5 years of combined treatment, central retinal artery occlusion occurred in the right eye. No thrombosis was found by cranial enhanced MRI, chest enhanced CT or by color Doppler ultrasound of carotid and cranial vessels, lower limb arteries and veins, and renal vessels. D-dimer was 0.5 mg·L-1 (within the normal range) and ophthalmic examinations were performed to rule out other eye diseases. Toripalimab might increase the risk of thromboembolism, which was suspected of aggravating the adverse reactions of axitinib. Axitinib was discontinued, eye massage was adopted, timolol eye drops were given to reduce intraocular pressure. Lidocaine, caceanisodamine hydrochloride and dexamethasone sodium phosphate were injected retrobulbarly to alleviate spasm. Urokinase was used for thrombolysis. Methylprednisolone sodium succinate 30 mg·d-1 was given intravenously. However, these medications failed to improve the visual acuity of the right eye, but no other ocular symptoms were found during the follow-up. Conclusion Axitinib combined with toripalimab is effective for advanced renal cell carcinoma. The combined treatment requires that the clinical symptoms and imaging characteristics of patients be monitored, and clinicians should be alert to the risk of central retinal artery occlusion.

Key words: axitinib, toripalimab, renal cancer, central retinal artery occlusion, combinations, adverse drug reactions

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