Acute progression of aspergillosis in a patient with lung cancer receiving nivolumab.
Acute progression of aspergillosis in a patient with lung cancer receiving nivolumab.
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DOI：
10.1002/rcr2.289
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发表时间：
2018-03
影响因子：
0.8
通讯作者：
Mio T
中科院分区：
文献类型：
--
作者：
Uchida N;Fujita K;Nakatani K;Mio T
一名患有慢性进行性肺曲霉病（CPPA）的65岁男性住院治疗肺腺癌，同时接受免疫检查点抑制剂纳武单抗治疗。肿瘤对治疗反应良好，但治疗20个疗程后，CPPA腔变大，与肿瘤形成对比。他被诊断为CPPA恶化，并成功地同时接受了抗真菌剂和纳武单抗治疗。由于纳武利尤单抗治疗期间没有明显的免疫抑制并且对肿瘤缓解存在巨大影响，这种现象表明CPPA进展的触发因素不依赖于免疫抑制，而是依赖于对微生物的过度反应，这类似于免疫重建炎症综合征由纳武利尤单抗引起。这是一个发人深省的案例，其中免疫检查点抑制剂对肿瘤和感染具有矛盾的作用。
A 65‐year‐old man with chronic progressive pulmonary aspergillosis (CPPA) was admitted for the treatment of lung adenocarcinoma while receiving an immune checkpoint inhibitor, nivolumab. The tumour responded well to the therapy, but the cavity of CPPA became large in contrast to the tumour after 20 courses of therapy. He was diagnosed as having exacerbation of CPPA and successfully and concurrently treated with an antifungal agent and nivolumab. Since there was absence of obvious immunosuppression and the presence of a drastic effect on tumour remission during nivolumab therapy, this phenomenon suggested that the trigger of CPPA progression was dependent not on immunosuppression but on a hyperreaction to microorganisms, which was similar to the immune reconstitution inflammatory syndrome caused by nivolumab. This was a thought‐provoking case in which the immune checkpoint inhibitor had a paradoxical effect for the tumour and infection.