Izumo Takehiro, Terada Yuriko, Tone Mari, Inomata Minoru, Kuse Naoyuki, Awano Nobuyasu, Moriya Atsuko, Jo Tatsunori, Yoshimura Hanako, Furuhata Yoshiaki
Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
Respir Med Case Rep. 2019 Feb 19;26:292-295. doi: 10.1016/j.rmcr.2019.02.015. eCollection 2019.
Severe bronchial asthma is a chronic disorder of the airways that may be accompanied by comorbid diseases. Invasive treatment, including surgery, in patients with severe asthma has limitations depending on the degree of control of the asthma. A 71-year-old woman was diagnosed with squamous cell carcinoma with high programmed death-ligand 1 (PD-L1) expression and cT3N0M1a. After 13 cycles of pembrolizumab every 3 weeks, chest computed tomography (CT) revealed a dramatic decrease in the lesion size in the left upper lobe, but the size of the lesion in the right lower lobe was significantly increased. The pathological findings of the right residual tumor by CT-guided transthoracic needle biopsy (CTNB) revealed squamous cell carcinoma with no PD-L1 expression, and right lower lobectomy was recommended. However, because the patient had frequent asthma attacks and cough, surgery was considered risky. Increased blood eosinophil count was observed, and benralizumab was administered for asthma control. The symptoms disappeared 2 days after benralizumab administration, and peak flow increased. Surgery was performed 5 days after benralizumab administration. There was a marked reduction in the eosinophil count of the surgical tissue compared with the preoperative CTNB tissue. No asthma attacks were observed during and after surgery, and the control of asthma and lung cancer was stable. Benralizumab is considered promising for the treatment of eosinophilic severe uncontrolled asthma.
重度支气管哮喘是一种气道慢性疾病，可能伴有合并症。重度哮喘患者的侵入性治疗（包括手术），其局限性取决于哮喘的控制程度。一名71岁女性被诊断为具有高程序性死亡配体1（PD-L1）表达的鳞状细胞癌，临床分期为cT3N0M1a。每3周接受13个周期的帕博利珠单抗治疗后，胸部计算机断层扫描（CT）显示左上叶病灶大小显著减小，但右下叶病灶大小显著增加。CT引导下经胸针吸活检（CTNB）获取的右肺残余肿瘤病理结果显示为无PD-L1表达的鳞状细胞癌，建议行右下叶切除术。然而，由于该患者频繁发作哮喘和咳嗽，手术被认为具有风险。观察到血液嗜酸性粒细胞计数增加，遂给予贝那利珠单抗控制哮喘。使用贝那利珠单抗2天后症状消失，呼气峰值流速增加。使用贝那利珠单抗5天后进行手术。与术前CTNB组织相比，手术组织中的嗜酸性粒细胞计数显著降低。手术期间及术后未观察到哮喘发作，哮喘和肺癌的控制情况稳定。贝那利珠单抗被认为在治疗嗜酸性粒细胞性重度难治性哮喘方面具有前景。
