Anti-PD-1 Inhibitor-Related Pneumonitis in Non-Small Cell Lung Cancer.
Anti-PD-1 Inhibitor-Related Pneumonitis in Non-Small Cell Lung Cancer.
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非小细胞肺癌中抗pd -1抑制剂相关肺炎
DOI：
10.1158/2326-6066.cir-15-0267
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发表时间：
2016-04
影响因子：
10.1
通讯作者：
Awad MM
中科院分区：
文献类型：
--
作者：
Nishino M;Chambers ES;Chong CR;Ramaiya NH;Gray SW;Marcoux JP;Hatabu H;Jänne PA;Hodi FS;Awad MM
最近批准的两种PD-1抑制剂用于治疗非小细胞肺癌（NSCLC），迅速导致这些药物在肿瘤学实践中的广泛使用。腹膜炎已被认为是接受PD-1抑制剂治疗的NSCLC患者中可能危及生命的不良事件;然而，该实体的详细临床和影像学表现仍有待描述。我们报告了两例在FDA批准后接受纳武利尤单抗治疗的晚期NSCLC患者发生抗PD-1肺炎的病例。这两例病例在CT上均表现为毛玻璃样和网状阴影，并在外周分布实变，显示出隐源性机化性肺炎（COP）的放射学模式。在这两种情况下，巩固是广泛的，并在治疗8周内迅速发展。两例患者均接受皮质类固醇治疗，随后呼吸道症状和影像学检查结果改善。1例患者在未接受纳武单抗再治疗的情况下，在完成皮质类固醇减量后发生复发性肺炎或“肺炎发作”，随后在皮质类固醇再给药后改善。随着免疫检查点抑制剂在越来越多的肿瘤类型中的使用越来越多，了解PD-1肿瘤相关性肺炎的影像学和临床表现对于及时诊断和管理这种潜在的严重不良事件至关重要。
The recent approval of two PD-1 inhibitors for the treatment of non–small cell lung cancer (NSCLC) has rapidly led to the widespread use of these agents in oncology practices. Pneumonitis has been recognized as a potentially life-threatening adverse event among NSCLC patients treated with PD-1 inhibitors; however, the detailed clinical and radiographic manifestations of this entity remain to be described. We report two cases of anti–PD-1 pneumonitis in advanced NSCLC patients treated with nivolumab after its FDA approval. Both cases presented with ground-glass and reticular opacities and consolidations in a peripheral distribution on CT, demonstrating a radiographic pattern of cryptogenic organizing pneumonia (COP). Consolidations were extensive and rapidly developed within 8 weeks of therapy in both cases. Both patients were treated with corticosteroids with subsequent improvement of respiratory symptoms and radiographic findings. One patient experienced recurrent pneumonitis after completing corticosteroid taper, or a “pneumonitis flare”, in the absence of nivolumab retreatment, with subsequent improvement upon corticosteroid re-administration. With the increasing use of immune checkpoint inhibitors in a growing number of tumor types, awareness of the radiographic and clinical manifestations of PD-1 inhibitor–related pneumonitis will be critical for the prompt diagnosis and management of this potentially serious adverse event.