A cikin marasa lafiya tare da melanoma na metastatic, haɗuwa da ipilimumab (CTLA4 antibody) da kuma shirin mutuwa (PD) -1 inhibitor nivolumab na iya inganta haɓakar hangen nesa. idan aka kwatanta da monotherapy . Dangane da waɗannan sakamakon, haɗin nivolumab da ipilimumab an amince da su ta FDA don kula da marasa lafiya tare da melanoma maras kyau ko metastatic. Ya zuwa yanzu, babu bayanai game da haɗin gwiwar yin amfani da nivolumab da ipilimumab don ciwon kai da wuyansa. A cewar sabon rahoto, wani mutum mai shekaru 46 da ke da kansa da kuma wuyansa ciwon daji.
A cikin Disamba 2016, an gano cutar sankarau mara kyau ta harshe pT1, pN2b, L1, V0, G3. Babu alamun kamuwa da cutar papillomavirus na ɗan adam. Bayan R0 resection da lymphadenectomy na mahaifa, ya karbi adjuvant chemoradiotherapy tare da cisplatin 35 mg / m2 mako-mako.
A cikin Afrilu 2016, CT scan na wuyansa ya nuna karuwa mai yawa a cikin ƙwayoyin lymph na mahaifa. Biopsy ya tabbatar da metastasis na node na lymph ba tare da alamun ƙarin metastasis ba. Ba za a iya cirewa ta hanyar tiyata ba, don haka 5-FU, cisplatin da cetuximab an yi amfani da su don tsarin chemotherapy mai tsanani. CT scans bayan sake zagayowar biyu ya nuna rashin lafiyar rashin lafiya (Hoto a).
Mai haƙuri yana da kyakkyawar magana ta PD-L1. Saboda rashin sauran zaɓuɓɓukan magani, nivolumab (3 mg / kg nauyin jiki kowane mako 2) da ipilimumab (1 mg / kg kowane mako 6) an fara a watan Yuli 2016. Ya kamata a lura cewa mai haƙuri yana da dogon lokaci autoimmune. ciwon hanta. Kwanaki goma bayan fara magani, an gano karuwa a cikin rheumatoid factor da enzymes hanta. MRI na hanta ya nuna babu rashin lafiyar cututtuka kuma serology na hanta ba shi da kyau.
Saboda zato na yiwuwar cutar hepatitis, an fara jiyya tare da prednisolone (100 mg / day), kuma an rage sifofin hanta sosai. Duk da haka, ci gaba da gudanar da ipilimumab da nivolumab, da kuma makonni 3 bayan gudanarwa ta biyu na ipilimumab, factor rheumatoid da hanta enzymes sun ƙaru amma sun sake raguwa bayan sake farawa prednisolone. A makonni 8 bayan fara jiyya, CT scans ya nuna cewa ƙari ya ragu sosai, kuma watanni 4 bayan jiyya (Hoto b), kusan cikakkiyar gafara (Figure c).
Wannan mai haƙuri ya sami cikakkiyar gafara bayan watanni 4 na jiyya, tare da matsakaici da mawuyacin sakamako masu illa. Sabili da haka, haɗuwa da nivolumab da ipilimumab na iya zama zaɓin magani mai fa'ida don ƙarancin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta kai da wuya. Gwaje-gwaje da yawa suna kwatanta ingancin hanyoyin rigakafin cutar kanjamau tare da daidaitattun ƙa'idodin ilimin kimiya, kuma muna ɗokin jiran sakamako.
