Pembrolizumab combined with stereotactic body radiotherapy in a patient with human immunodeficiency virus and advanced non-small cell lung cancer: a case report.
Pembrolizumab combined with stereotactic body radiotherapy in a patient with human immunodeficiency virus and advanced non-small cell lung cancer: a case report.
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帕博利珠单抗联合立体定向放疗治疗人类免疫缺陷病毒合并晚期非小细胞肺癌一例
DOI：
10.1186/s13256-018-1667-2
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发表时间：
2018-04-23
影响因子：
1
通讯作者：
Zhang, Jing
中科院分区：
文献类型：
--
作者：
Li, Dongqi;He, Chuanchun;Zhang, Jing
背景Pembrolizumab 显着改善晚期非小细胞肺癌患者的预后。程序性死亡1抑制剂与立体定向放射治疗相结合，在最近的临床试验中显示出轻微的毒性和良好的获益。然而，感染人类免疫缺陷病毒的患者被排除在大多数试验之外，因为人们认为与免疫功能正常的患者相比，他们的抗肿瘤免疫力受到损害。病例介绍2016 年 6 月，一名 52 岁的中国男性出现人类免疫缺陷病毒和肺腺癌 (T1bN3M1b)。 2016年11月至2016年12月对股骨颈骨转移进行全身化疗及姑息性放疗，但肿瘤进展。 2017年1月，免疫化学检测程序性死亡-1和程序性死亡-配体1表达（均> 50%）后，开始使用派姆单抗。帕博利珠单抗治疗三周后，我们对原发性肺部肿瘤联合立体定向全身放疗。他没有得到安慰，CD4 淋巴细胞计数稳定。人类免疫缺陷病毒核糖核酸仍低于检测限。 2017年3月，经过三个周期的派姆单抗和5周的立体定向放射治疗后，他突然出现心悸。紧急计算机断层扫描显示大量心包积液和间质性肺炎。因此，我们中断了派姆单抗的使用，并开始使用泼尼松龙 1 mg/kg 进行治疗；然而，肿瘤却进展了。然后，他的 CD4 淋巴细胞计数下降。最终于2017年6月因恶液质死亡。结论派姆单抗联合SBRT治疗人类免疫缺陷病毒感染和非小细胞肺癌患者可能会导致严重的免疫相关不良事件，需要更多的临床试验。
BackgroundPembrolizumab has significantly improved outcomes in patients with advanced non-small cell lung cancer. Combining programmed death-1 inhibitor with stereotactic body radiotherapy showed a slight toxicity and good benefits in recent clinical trials. However, patients infected with human immunodeficiency virus were excluded from most trials because it was assumed that their anti-tumor immunity was compromised compared with immunocompetent patients.Case presentationIn June 2016, a 52-year-old Chinese man presented with human immunodeficiency virus and lung adenocarcinoma (T1bN3M1b). From November 2016 to December 2016, systemic chemotherapy and palliative radiotherapy for bone metastasis of femoral neck were carried out, but the tumor progressed. In January 2017, after immunochemistry detection of programmed death-1 and programmed death-ligand 1 expression (both > 50%), pembrolizumab was started. Three weeks after pembrolizumab, we combined stereotactic body radiotherapy for the primary lung tumor. He received no comfort and his CD4 lymphocyte count was stable. Human immunodeficiency virus-ribonucleic acid remained below the limits of detection. In March 2017, after three cycles of pembrolizumab and 5 weeks of stereotactic body radiotherapy therapy, he suddenly presented with palpitations. Emergency computed tomography scanning showed massive pericardial effusion and interstitial pneumonia. So we interrupted the pembrolizumab use and initiated treatment with prednisolone 1 mg/kg; however, the tumor progressed. Then, his CD4 lymphocyte count declined. Finally he died in June 2017 due to dyscrasia.ConclusionsPembrolizumab combined with SBRT therapy for patients with human immunodeficiency virus infection and non-small cell lung cancer may lead to serious immune-related adverse events and more clinical trials are needed.