Bukaannada qaba melanoma melanoma, isku darka ipilimumab (CTLA4 antibody) iyo dhimashada barnaamijka (PD) -1 inhibitor nivolumab ayaa si weyn u wanaajin kara saadaasha. marka la barbar dhigo monotherapy . Iyada oo ku saleysan natiijooyinkaan, isku-darka nivolumab iyo ipilimumab ayaa FDA u ansixisay daaweynta bukaannada qaba melanoma aan la daboolin ama metastatic. Ilaa hadda, ma jiraan wax xog ah oo ku saabsan isticmaalka la isku daray ee nivolumab iyo ipilimumab ee kansarka qoorta iyo madaxa unugga squamous. Sida laga soo xigtay warbixintii ugu dambeysay, nin 46 jir ah oo qaba madaxa unugga squamous-ka iyo qoorta kansarkanivolumabDaawaynta ipilimumab ee la isku daray ayaa aad loogu guulaystay.
Bishii Disembar 2016, kansarka unugyada squamous cell carcinoma pT1, pN2b, L1, V0, G3 ayaa la ogaaday. Ma jiraan wax calaamado ah oo ah infakshanka papillomavirus ee bini'aadanka. Ka dib dib-u-soo-celinta R0 iyo lymphadenectomy ilmo-galeenka, wuxuu helay daaweynta chemoradiotherapy adjuvant leh cisplatin 35 mg / m2 toddobaadle ah.
Bishii Abriil 2016, baarista CT ee qoorta ayaa muujisay koror weyn oo ah qanjidhada ilmagaleenka ilmo-galeenka. Biopsi ayaa la xaqiijiyay metastasis-ka qanjidhada qanjirada oo aan lahayn calaamado sii dheeraad ah. Qalliin lagama saari karo, sidaa awgeed 5-FU, cisplatin iyo cetuximab ayaa loo isticmaalay daawaynta kimikalka ee habaysan. Baadhitaannada CT-ga ee laba wareeg ka dib waxay muujiyeen xasillooni xanuun oo liidata (Jaantuska a).
Bukaanku wuxuu lahaa hadal togan oo PD-L1 ah. Sababtoo ah la'aanta fursadaha kale ee daaweynta, nivolumab (3 mg / kg miisaanka jirka 2dii toddobaadba) iyo ipilimumab (1 mg / kg 6 toddobaad kasta) ayaa la bilaabay July 2016. Waxaa xusid mudan in bukaanku leeyahay difaaca jirka ee muddada dheer. cagaarshow. Toban maalmood ka dib bilawga daaweynta, kororka rheumatoid factor iyo enzymes beerka ayaa la ogaaday. Beerka MRI ma muujin wax cillado ah oo aan caadi ahayn iyo serology cagaarshowga ayaa ahaa mid xun.
Sababtoo ah shaki laga qabo cagaarshowga difaaca jirka ee sababi kara, daaweynta prednisolone (100 mg / maalin) ayaa la bilaabay, iyo xuduudaha beerka si weyn ayaa loo yareeyay. Si kastaba ha noqotee, sii socoshada maamulka ipilimumab iyo nivolumab, iyo 3 todobaad kadib maamulkii labaad ee ipilimumab, cudurka rheumatoid iyo enzymes beerka ayaa kordhay laakiin markale ayaa hoos udhacay kadib markii dib loo bilaabay prednisolone. 8 todobaad kadib bilowgii daaweynta, baaritaanada CT waxay muujiyeen in burooyinka si aad ah loo yareeyay, iyo 4 bilood daaweynta kadib (Jaantus b), ku dhowaad dhammaystir dhammaystiran (Jaantus c).
Bukaankani wuxuu gaadhay dhammaystir dhammaystiran ka dib 4 bilood oo daaweyn ah, oo leh waxyeelo dhexdhexaad ah oo la beddeli karo. Sidaa darteed, isticmaalka isku dhafan ee nivolumab iyo ipilimumab wuxuu noqon karaa ikhtiyaar daaweyn rajo leh oo loogu talagalay ka hortagga unugyada unugyada unugyada jirka ee madaxa iyo qoorta. Tijaabooyin dhowr ah ayaa isbarbardhigaya waxtarka hababka difaaca jirka ee kansarka leh nidaamyada daaweynta kiimiko ee caadiga ah, waxaanan si xiiso leh u sugeynaa natiijooyinka.
