Recurrent Episodes of Nivolumab-Induced Pneumonitis after Nivolumab Discontinuation and the Time Course of Carcinoembryonic Antigen Levels: A Case of a 58-Year-Old Woman with Non-Small Cell Lung Cancer
Recurrent Episodes of Nivolumab-Induced Pneumonitis after Nivolumab Discontinuation and the Time Course of Carcinoembryonic Antigen Levels: A Case of a 58-Year-Old Woman with Non-Small Cell Lung Cancer
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DOI：
10.1159/000494841
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发表时间：
2018-01-01
期刊：
影响因子：
3.3
通讯作者：
Schramel, Franz M. N. H.
中科院分区：
文献类型：
--
作者：
de Jong, Corine;Peters, Bas J. M.;Schramel, Franz M. N. H.
免疫检查点抑制剂的引入预示着非小细胞肺癌治疗的新时代。然而，抗PD-1抗体nivolumab可能导致严重的不良事件，这些不良事件大多与自身免疫相关。病例介绍：一名58岁女性接受纳武单抗作为IV期腺癌的二线治疗。该患者在nivolumab治疗7个周期后出现持续临床缓解之前发生了nivolumab诱导的复发性肺炎。尽管高剂量糖皮质激素逐渐减少以符合当代指南，但在没有纳武利尤单抗再激发的情况下发生了肺炎复发。此外，癌胚抗原（CEA）血清水平与治疗反应相关，因为CEA下降与接近完全的放射学反应相关，相反，CEA血清水平升高与疾病进展相关。结论：在这种情况下，我们将nivolumab诱导的肺炎复发描述为免疫检查点抑制剂的严重不良事件。我们的病例说明，免疫相关不良事件可能与抗肿瘤活性相关，即使在治疗停止后。此外，该病例提示CEA血清水平可能用于评估免疫治疗的（持久）效果。(C)2018 S. Karger AG，巴塞尔
Introduction: The introduction of immune checkpoint inhibitors heralded a new era in the treatment of non-small cell lung cancer. However, nivolumab, an anti-PD-1 antibody, can cause serious adverse events that are mostly autoimmune related. Case Presentation: A 58-year-old woman was treated with nivolumab as second-line therapy for stage IV adenocarcinoma. The patient developed a nivolumab-induced recurrent pneumonitis preceding durable clinical remission after seven cycles of nivolumab. Although high-dose glucocorticosteroids were tapered to conform to contemporary guidelines, recurring episodes of pneumonitis occurred without nivolumab rechallenge. In addition, carcinoembryonic antigen (CEA) serum levels were associated with treatment response, since CEA decline correlated with a near complete radiological response and, conversely, elevated CEA serum levels were associated with progressive disease. Conclusions: In this case, we described recurrence of nivolumab-induced pneumonitis as a serious adverse event in immune checkpoint inhibitors. Our case illustrates that immune-related adverse events may correlate with antitumour activity, even after treatment discontinuation. In addition, this case suggests the possible clinical utility of CEA serum levels for the assessment of (durable) effects of immunotherapy. (C) 2018 S. Karger AG, Basel