摘要
目的:探讨程序性细胞死亡蛋白1及其配体(PD-1/PD-L1)抑制剂在胸腺瘤治疗中的应用。方法:回顾性分析四川大学华西医院收治的1例晚期胸腺瘤患者使用PD-1抑制剂pembrolizumab的临床资料并对相关文献进行回顾。以"PD-1 inhibitor"、"PD-L1 inhibitor"、"pembrolizumab"、"nivolumab"或"atezolizumab"联合"thymoma"检索Pubmed数据库,检索时间截止至2019年9月30日。结果:患者男,26岁,B2/B3型胸腺瘤,在多次姑息性手术治疗,多线化疗,纵隔放疗后病情出现进展,后续使用PD-L1抑制剂pembrolizumab联合培美曲塞治疗,在第一次使用pembrolizumab治疗后患者出现免疫相关心肌炎,经甲基强的松龙治疗后好转,药物减停过程中患者出现心肌炎复燃,并伴随全身多器官功能障碍,最后在使用PD-1抑制剂后5个月死亡。在Pubmed数据库共检索到5篇文献共12例胸腺瘤患者使用免疫治疗,加上本例共13例。在这13例使用PD-1抑制剂的患者中,9例进行了疗效评价,3例患者达到部分缓解,6例患者疾病稳定;然而有11例患者出现免疫相关不良事件,6例患者死亡。结论:PD-1抑制剂在胸腺瘤中显示出良好的抗肿瘤活性,同时也具有很高的不良反应发生率及致死率,在临床应用中应慎重考虑患者的获益和风险。
Objective:To investigate the application of programmed cell death protein 1(PD-1)/PD-L1 inhibitors in thymoma.Methods:The clinical data of a patient with advanced thymoma received pembrolizumab treatment in West China Hospital of Sichuan University were retracted and analysed retrospectively and the related literatures were reviewed in Pubmed.We searched the Pubmed database using the keywords"PD-1 inhibitor","PD-L1 inhibitor","pembrolizumab","nivolumab"or"atezolizumab"combined with"thymoma"by September 30,2019.Results:The patient,a 26-year-old male,B2/B3 thymoma,was treated with PD-L1 inhibitor pembrolizumab combined with pemetrexed after multiple palliative surgery,multi-line chemotherapy and mediastinal radiotherapy.After using the first dose of pembrolizumab,patient suffered immune-associated myocarditis that improved by methylprednisolone treatment.Unfortunately,after the dose of hormone was decresed by doctor,the condition rekindled,and finally patient died.A total of 13 cases thymoma were treated with immunotherapy that were included in our study,contained 12 cases in 5 articles in Pubmed database and 1 case in our hospital.Of the 13 patients with thymoma treated with PD-1 inhibitor,9 patients were evaluated,of which 3 patients achieved partial response and 6 patients had stable disease,but 11 patients had immune-related adverse events and 6 patients died.Conclusion:Although PD-1 inhibitor has good antitumor activity in thymoma,it also has high toxicity and mortality.Its efficacy and risk should be carefully considered in clinical practice.
作者
龙浪
罗锋
王力
鄢国清
Long Lang;Luo Feng;Wang Li;Yan Guoqing(West China Hospital of Sichuan University,Sichuan Chengdu 610041,China;Minda Hospital of Hubei Minzu University,Hubei Enshi 445000,China)
出处
《现代肿瘤医学》
CAS
2020年第17期2977-2981,共5页
Journal of Modern Oncology
基金
国家自然科学基金资助项目(编号:81802512)。
