Petri Camille R, Patell Rushad, Batalini Felipe, Rangachari Deepa, Hallowell Robert W
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Respir Med Case Rep. 2019 Apr 6;27:100834. doi: 10.1016/j.rmcr.2019.100834. eCollection 2019.
Immune checkpoint inhibitors are known to cause a variety of immune-related adverse events, including pneumonitis. When symptomatic, treatment typically consists of temporary or permanent cessation of the checkpoint inhibitor and several weeks of corticosteroid therapy. However, a subset of patients may suffer from severe pneumonitis, and the optimal treatment for this group is not known. Here we describe the case of a patient receiving pembrolizumab for non-small cell lung cancer who developed severe checkpoint inhibitor pneumonitis. After treatment with high-dose corticosteroids failed to produce a response, a course of intravenous immunoglobulin catalyzed rapid and durable improvement. In this review, we discuss the current evidence regarding the incidence and outcomes of severe checkpoint inhibitor pneumonitis and propose a role for intravenous immunoglobulin as a possible treatment strategy.
免疫检查点抑制剂已知会引发多种免疫相关不良事件，包括肺炎。出现症状时，治疗通常包括暂时或永久停用检查点抑制剂以及数周的皮质类固醇治疗。然而，一部分患者可能会患上严重肺炎，而这组患者的最佳治疗方法尚不清楚。在此，我们描述了一例接受派姆单抗治疗非小细胞肺癌的患者，该患者发生了严重的检查点抑制剂肺炎。在高剂量皮质类固醇治疗无效后，静脉注射免疫球蛋白疗程促使病情迅速且持久改善。在本综述中，我们讨论了关于严重检查点抑制剂肺炎的发病率和预后的现有证据，并提出静脉注射免疫球蛋白作为一种可能的治疗策略的作用。
