An esophageal cancer case of cytokine release syndrome with multiple-organ injury induced by an anti-PD-1 drug: a case report
An esophageal cancer case of cytokine release syndrome with multiple-organ injury induced by an anti-PD-1 drug: a case report
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DOI：
10.21037/apm-20-1310
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发表时间：
2020-07-01
影响因子：
--
通讯作者：
Yu, Qiyao
中科院分区：
文献类型：
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作者：
Gao, Chao;Xu, Jinsheng;Yu, Qiyao
当抗PD-1药物以健康组织为靶点时，可能会引起免疫相关不良事件(IrAEs)。血液毒性和肾脏免疫相关的不良反应很少见；这些事件通常在临床上是严重的，并危及生命。在这项研究中，我们首次报道了一例老年食道癌(ESC)患者，在抗PD-1药物治疗后，放射治疗导致细胞因子释放综合征(CRS)和irAEs。1例69岁男性ESC患者于2019年12月2日住院，接受了多西紫杉醇和奈达铂三个周期的化疗，同时加用PD-1抑制剂(Sintilimab)。由于没有任何反应，化疗计划被中断。采用三维适形放射治疗(60Gy30次，5次/周)治疗食道病变。放疗6次后出现轻度腹泻、间歇性低热、白细胞减少等典型CRS和irAEs，对症治疗后缓解。然而，放疗10次后意外提前结束，患者血小板水平显著下降至31×10(9)/L，血肌酐从78.4mU/L急剧上升至609.5 mU/L。CT扫描显示双肺弥漫性炎症。研究还显示，纵隔淋巴结和食道病变明显减少，患者接受了糖皮质激素等免疫调节剂的对症治疗。在综合治疗改善irAEs症状后，患者出院了。根据PD-1抗肿瘤治疗策略，在放射治疗过程中，CRS和多器官损伤可能成为潜在的irAEs，并讨论了这些不良事件的处理。
When anti-PD-1 drugs target healthy tissues, it may cause immune-related adverse events (irAEs). Hematological toxicities and renal immune-related adverse reactions were rare; these events recorded were often clinically severe and life-threatening. In this study, we first reported on an elderly esophageal cancer (ESC) case of cytokine release syndrome (CRS) and irAEs induced by radiotherapy following anti-PD-1 drug treatment. A 69-year-old male patient with ESC was hospitalized on December 2, 2019, after three cycles of chemotherapy with docetaxel and nedaplatin accompanied by the addition of PD-1 inhibitor (Sintilimab). The chemotherapy scheme was interrupted due to the absence of any response. Instead, three-dimensional conformal radiotherapy (60 Gy/30 times, 5 times/week) was locally applied to treat the esophageal lesion. Typical CRS and irAEs, including mild diarrhea, intermittent low fever, and leukopenia, occurred after 6 times of radiotherapy, which was alleviated by symptomatic treatment. Such radiotherapy, however, encountered an unexpected early ending after 10 times with patient platelet level being significantly decreased to 31x10(9)/L and the serum creatinine of the patients sharply increased from 78.4 to 609.5 mu mol/L. CT scan presented scattered inflammation in both lung. It also showed that mediastinal lymph nodes and esophageal lesions were significantly reduced, and the patients received symptomatic treatment of glucocorticoids and other immunomodulators. The patient get discharged from the hospital after the combination treatment improved the irAEs symptoms. This paper showed the possibility of CRS and multiple-organ injuries as potential irAEs during radiotherapy following the anti-PD-1 therapy strategy and discussed the management of these adverse events (AEs).