Pneumonitis in cancer patients receiving anti-PD-1 and radiotherapies Three case reports
Pneumonitis in cancer patients receiving anti-PD-1 and radiotherapies Three case reports
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DOI：
10.1097/md.0000000000005747
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发表时间：
2017-01-01
期刊：
影响因子：
1.6
通讯作者：
Liu, Jin-Hwang
中科院分区：
文献类型：
--
作者：
Lu, Chieh-Sheng;Liu, Jin-Hwang
简介：在开发用于治疗癌症患者的新疗法中，使用放射治疗（RT）可以产生显著的局部控制，并且在最近的研究中，还显示通过触发和增强内源性细胞免疫应答来介导远端部位的抗肿瘤应答。尽管RT在一些患者中诱导了远位效应，这是由于对肿瘤的免疫应答增强，但免疫逃逸机制，包括肿瘤细胞上程序性死亡配体1（PD-L1）的上调，限制了其他患者的这种益处。因此，许多研究促进了RT和抗程序性细胞死亡蛋白1（PD-1）治疗的抗肿瘤免疫的协同作用。然而，结果可能会得到改善，当更多的治疗相结合，但副作用的风险可以increasing.Case介绍：我们在此提出3例晚期癌症患者肺转移和谁收到RT。后来，他们接受了抗PD-1治疗，不幸的是遭受抗PD-1相关的肺炎在nonradiated领域后4个周期的治疗。上调细胞PD-1的表达在这些领域被认为是抗PD-1治疗的免疫过度反应可能会导致这些严重的肺adverse effects. Conclusion：我们审查3例值得仔细的检查，以减少副作用的风险，通过联合治疗与RT和抗PD-1治疗。
Introduction: In development of novel therapies for the treatment of patient with cancer, the use of radiotherapy (RT) can produce significant local control and, in recent studies, has also been shown to mediate anti-tumor responses at distant sites by triggering and enhancing the endogenous cellular immune responses. Although RT induces an abscopal effect in some patients due to enhanced immune response to the tumor, immune-escape mechanisms, including up-regulation of programmed death-ligand 1 (PD-L1) on tumor cells, limit this benefit in other patients. Hence, many studies have promoted the synergy of RT and anti-programmed cell death protein 1 (PD-1) treatment for antitumor immunity. However, outcome may be improved when more therapies are combined, but risk of side effects can be increased.Case Presentation: We herein present 3 advanced cancer patients with pulmonary metastasis and who received RT. Later, they underwent anti-PD-1 treatment and unfortunately suffered from anti-PD-1-related pneumonitis over the nonirradiated areas after 4 cycles of treatment. The upregulation of cellular PD-1 expression in these areas was considered and the immune overreaction by anti-PD-1 treatment may cause these severe pulmonary adverse effects.Conclusion: Our review of 3 cases warrants careful workup to reduce the risk of side effects by combinative therapy with RT and anti-PD-1 treatment.