Carter Corey A, Browning Robert, Oronsky Bryan T, Scicinski Jan J, Brzezniak Christina
Walter Reed National Military Medical Center, Bethesda, Md., USA.
EpicentRx, Mountain View, Calif., USA.
Case Rep Oncol. 2016 Jan 27;9(1):68-75. doi: 10.1159/000443723. eCollection 2016 Jan-Apr.
A case report of a 47-year-old woman with triple-negative breast cancer on a clinical trial called PRIMETIME (NCT02518958) who received the anti-PD-1 inhibitor nivolumab and the experimental anticancer agent RRx-001 is presented. Although initially diagnosed and treated for anti-PD-1-induced pneumonitis, clinical and radiological abnormalities triggered further investigation, leading to the diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM). This example highlights the importance of exercising due diligence in determining immune-related adverse events and suggests that PD-1-induced pneumonitis should be a diagnosis of exclusion rather than a diagnosis by default. A case history and review of the literature are presented for PTTM, which we propose to define as a paraneoplastic syndrome.
本文报告了一名47岁三阴性乳腺癌女性患者的病例，该患者参与了一项名为PRIMETIME（NCT02518958）的临床试验，接受了抗PD-1抑制剂纳武单抗和实验性抗癌药物RRx-001治疗。尽管最初被诊断为抗PD-1诱导的肺炎并接受了相应治疗，但临床和影像学异常促使进一步检查，最终诊断为肺肿瘤血栓性微血管病（PTTM）。这个例子强调了在确定免疫相关不良事件时应尽职调查的重要性，并表明PD-1诱导的肺炎应是排除性诊断而非默认诊断。本文还介绍了PTTM的病例史及文献综述，我们建议将其定义为一种副肿瘤综合征。
