Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Thorac Cancer. 2018 Nov;9(11):1522-1524. doi: 10.1111/1759-7714.12872. Epub 2018 Sep 25.
Nivolumab, an anti-PD-1 antibody, has been shown to be effective in many cancers, such as malignant melanoma and lung cancer; however, nivolumab therapy can result in pseudoprogression. Diffuse alveolar hemorrhage (DAH) is persistent or recurrent pulmonary hemorrhage as a result of drugs, autoimmune diseases, or infections. DAH with pseudoprogression during nivolumab administration has rarely been reported. Herein, we describe our experience with one such case. A 41-year-old woman exhibited bloody sputum and ground glass opacities in the lungs along with tumor growth during nivolumab therapy for multiple lung metastases of malignant melanoma. We diagnosed DAH with pseudoprogression as a result of nivolumab and administered steroid therapy. The DAH subsequently improved and the tumor shrank. This case illustrates that nivolumab can cause DAH with pseudoprogression, which can be controlled by steroid therapy. Thus, if bloody sputum and ground glass opacities in the lungs are observed with tumor growth during nivolumab administration, steroid therapy should be considered to control DAH with pseudoprogression.
纳武利尤单抗是一种抗 PD-1 抗体，已被证明在多种癌症中有效，如恶性黑色素瘤和肺癌；然而，纳武利尤单抗治疗可能导致假性进展。弥漫性肺泡出血（DAH）是由于药物、自身免疫性疾病或感染导致的持续或复发性肺出血。纳武利尤单抗治疗期间出现的伴有假性进展的 DAH 很少见。在此，我们描述了我们遇到的这样一个病例。一名 41 岁女性在接受纳武利尤单抗治疗恶性黑色素瘤多发肺转移期间出现咯血和肺部磨玻璃影，同时伴有肿瘤生长。我们诊断为纳武利尤单抗引起的 DAH 伴假性进展，并给予激素治疗。随后 DAH 改善，肿瘤缩小。该病例表明，纳武利尤单抗可引起伴有假性进展的 DAH，可通过激素治疗控制。因此，如果在纳武利尤单抗治疗期间观察到咯血和肺部磨玻璃影伴肿瘤生长，应考虑激素治疗来控制伴有假性进展的 DAH。
