RESUMO
Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery) hyperintensity of the mesial temporal lobes, and there were anti-Ma2 antibodies in both serum and cerebrospinal fluid. She was treated with corticosteroids but developed further clinical relapses requiring immunoglobulin and rituximab. The immune-related adverse events relating to immune checkpoint inhibitors are an emerging challenge for the neurologist. Some cases are refractory and require serial immunosuppression.
Assuntos
Antígenos de Neoplasias/metabolismo , Autoanticorpos/metabolismo , Encefalite/tratamento farmacológico , Encefalite/metabolismo , Doença de Hashimoto/tratamento farmacológico , Doença de Hashimoto/metabolismo , Inibidores de Checkpoint Imunológico/uso terapêutico , Proteínas do Tecido Nervoso/metabolismo , Autoanticorpos/efeitos dos fármacos , Encefalite/diagnóstico por imagem , Feminino , Doença de Hashimoto/diagnóstico por imagem , Humanos , Inibidores de Checkpoint Imunológico/farmacologia , Pessoa de Meia-IdadeRESUMO
The paper deals with the evaluation of the performance of an existing and previously validated CT based radiomic signature, developed in oropharyngeal cancer to predict human papillomavirus (HPV) status, in the context of anal cancer. For the validation in anal cancer, a dataset of 59 patients coming from two different centers was collected. The primary endpoint was HPV status according to p16 immunohistochemistry. Predefined statistical tests were performed to evaluate the performance of the model. The AUC obtained here in anal cancer is 0.68 [95% CI (0.32-1.00)] with F1 score of 0.78. This signature is TRIPOD level 4 (57%) with an RQS of 61%. This study provides proof of concept that this radiomic signature has the potential to identify a clinically relevant molecular phenotype (i.e., the HPV-ness) across multiple cancers and demonstrates potential for this radiomic signature as a CT imaging biomarker of p16 status.