摘要
背景与目的免疫检查点抑制剂相关肺炎(checkpoint inhibitor pneumonitis, CIP)是严重的免疫检查点抑制剂副反应,急性期治疗手段已有共识,但急性期之后的肺间质纤维化治疗手段仍是临床需要解决的问题。方法回顾性分析了青岛市中心医院立体定向放疗科收治的1例细胞程序性死亡受体1(programmed cell death1, PD-1)单抗导致免疫检查点抑制剂相关肺炎的非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的诊断、治疗过程,并文献复习。结果患者男性,70岁,初始诊断:左肺低分化鳞癌T3N3M0 IIIc期纵隔淋巴结转移表皮生长因子受体(epidermal growth factor receptor, EGFR)/间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)/原癌基因1酪氨酸激酶(C-ros oncogene 1receptor tyrosine kinase, ROS1)/RAF阴性PD-L1(22C3)阴性。一线化疗进展后纳武利尤单抗单药二线治疗过程中确诊为免疫检查点抑制剂相关肺炎3级。初始大剂量糖皮质激素冲击治疗后患者肺部计算机断层扫描(computed tomography, CT)影像学和临床症状部分缓解,随后给予吡非尼酮口服(300 mg tid)11个月余,治疗过程中患者CT影像学和临床症状明显好转,除1级恶心外无其他不良反应。期间吡非尼酮与化疗、安罗替尼联合应用安全性好。结论本病例报道为目前吡非尼酮治疗CIP的第1例报道,为CIP治疗的临床实践和临床研究提出了新的思路。
Background and objective Immune checkpoint inhibitor associated pneumonia(CIP) is a serious side effect of immune checkpoint inhibitors. There is a consensus on the treatment of acute phase of CIP, but the treatment of pulmonary interstitial fibrosis after the acute phase is still a clinical problem to be solved. Methods The diagnosis and treatment of a non-small cell lung cancer(NSCLC) patient with immune checkpoint inhibitor associated pneumonia in the Stereotactic Radiotherapy Department of Qingdao Central Hospital were retrospectively analyzed, and literatures were reviewed. Results A 70-year-old male patient was diagnosed with Poorly differentiated squamous cell carcinoma of left lung with mediastinal lymph node metastasis T3 N3 M0 stage IIIc, EGFR/ALK/ROS1/RAF negative, PD-L1(22 c3) immunohistochemistry negative. After the progression of first-line chemotherapy, the patient was diagnosed as immune checkpoint inhibitor associated pneumonia grade 3 during second-line monotherapy with Nivolumab. After initial highdose glucocorticoid pulse therapy, the lung computed tomography(CT) imaging and clinical symptoms of the patients were partially relieved, and then pirfenidone(300 mg tid) was given orally for more than 11 months. During the treatment of pirfenidone, the CT imaging and clinical symptoms of the patients were significantly improved, and there were no other adverse reactions except grade 1 nausea. During this period, chemotherapy and Anlotinib was given concurrently with pirfenidone and showed good safety profile. Conclusion This case report is the first report of pirfenidone in the treatment of CIP, which provides a new idea for the clinical practice and research of CIP treatment.
作者
于海明
李进英
于兰
程曦
韩晓娜
张小涛
Haiming YU;Jinying LI;Lan YU;Xi CHENG;Xiaona HAN;Xiaotao ZHANG(Department of Stereotactic Radiotherapy,Qingdao Central Hospital,Qingdao 266042,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2021年第7期519-525,共7页
Chinese Journal of Lung Cancer
关键词
免疫检查点抑制剂
肺炎
PD-1单抗
吡非尼酮
肺肿瘤
Immune checkpoint inhibitors
Pneumonia
PD-1 monoclonal antibody
Pirfenidone
Lung neo plasms
