He Wan, Zhang Xiangmei, Li Wenwen, Kong Cheng, Wang Yuanyang, Zhu Lianyu, Xu Ruilian, Deng Guofang, Zhang Peize
Department of Oncology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong 518020, China.
Department of Pathology, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong 518112, China.
Onco Targets Ther. 2018 Oct 24;11:7423-7427. doi: 10.2147/OTT.S178246. eCollection 2018.
PD-1 checkpoint inhibitors have shown a robust tumor response in the treatment of various cancers. Pembrolizumab is an anti-PD-1 checkpoint antibody approved for the treatment of unresectable or metastatic melanoma in more than 40 countries. Although autoimmune pneumonitis is considered a common immune-related adverse event of PD-1 inhibitors, only limited studies have assessed the development of opportunistic infections such as pulmonary tuberculosis (TB).
A patient with metastatic melanoma whose pulmonary TB was activated after administration of pembrolizumab for melanoma is reported. Anti-TB drugs were administered, followed by pembrolizumab (2 mg/kg, repeated every 28 days), which successfully cured the TB and achieved complete response for melanoma.
Activated pulmonary TB was observed during the administration of pembrolizumab. It was safe and effective in the current patient to combine anti-TB drugs and PD-1 inhibitors. More importantly, screening pulmonary TB before administration of PD-1 inhibitors is recommended.
程序性死亡受体1（PD-1）检查点抑制剂在多种癌症治疗中已显示出强大的肿瘤反应。帕博利珠单抗是一种抗PD-1检查点抗体，已在40多个国家获批用于治疗不可切除或转移性黑色素瘤。尽管自身免疫性肺炎被认为是PD-1抑制剂常见的免疫相关不良事件，但仅有有限的研究评估了诸如肺结核（TB）等机会性感染的发生情况。
报告了1例转移性黑色素瘤患者，其在接受帕博利珠单抗治疗黑色素瘤后发生了活动性肺结核。给予抗结核药物治疗，随后使用帕博利珠单抗（2mg/kg，每28天重复给药），成功治愈了肺结核，并使黑色素瘤达到完全缓解。
在使用帕博利珠单抗期间观察到了活动性肺结核。在当前患者中，联合使用抗结核药物和PD-1抑制剂是安全有效的。更重要的是，建议在使用PD-1抑制剂前筛查肺结核。
