Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of State Guest, Institute of Health Management, The Second Medical Center of Chinese PLA General Hospital, Beijing, China.
Ann Palliat Med. 2020 Sep;9(5):3623-3628. doi: 10.21037/apm-20-1134. Epub 2020 Jul 9.
For patients with advanced non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs) can offer an effective treatment. However, despite their potential benefits, the use of ICIs can lead to inflammation in various organs, including pneumonitis. Interstitial lung disease (ILD), which is a common complication in patients with NSCLC, can increase the risk of pneumonitis. For NSCLC patients with ILD, the safety of ICIs has yet to be established. Durvalumab is a selective, high-affinity, engineered, human IgG1 monoclonal antibody, which showed durable response and manageable side effects in stage III NSCLC patients after definitive chemoradiotherapy. Pneumonitis in patients who received durvalumab was mostly low grade, given the potential applications in NSCLC with ILD. A 77-year-old man was diagnosed with Stage IV lung squamous carcinoma and ILD at our hospital. The PD-L1 expression assessed by VENTANA PD-L1 (SP263) Assay showed about 60% of tumor cells exhibit positive. Because the patient refused chemotherapy, he was given durvalumab at 20 mg/kg every 4 weeks as first-line anti-tumor therapy. After four cycles of therapy, the patient achieved partial remission, and complete remission(CR) had been achieved after 6 cycles of therapy and maintained over two years. No immune-related adverse events were reported. In this case, PD-L1 inhibitors were used to safely treat an NSCLC patient with ILD, which presents the need for further evaluation of their use.
对于晚期非小细胞肺癌（NSCLC）患者，免疫检查点抑制剂（ICIs）可提供有效的治疗。然而，尽管它们有潜在的益处，ICI 的使用可能导致各种器官的炎症，包括肺炎。间质性肺疾病（ILD）是 NSCLC 患者的常见并发症，会增加肺炎的风险。对于有 ILD 的 NSCLC 患者，ICI 的安全性尚未确定。度伐鲁单抗是一种选择性、高亲和力、工程化的人 IgG1 单克隆抗体，在接受根治性放化疗的 III 期 NSCLC 患者中显示出持久的缓解和可管理的副作用。接受度伐鲁单抗治疗的患者的肺炎大多为低级别，因为它有在 ILD 合并的 NSCLC 中应用的潜力。一名 77 岁男性因在我院诊断为 IV 期肺鳞癌和 ILD。由 VENTANA PD-L1（SP263）检测评估的 PD-L1 表达显示约 60%的肿瘤细胞呈阳性。由于患者拒绝化疗，他被给予 20mg/kg 的度伐鲁单抗，每 4 周一次作为一线抗肿瘤治疗。经过四个周期的治疗，患者达到部分缓解，经过六个周期的治疗达到完全缓解（CR），并维持了两年多。未报告免疫相关不良事件。在这种情况下，使用 PD-L1 抑制剂安全地治疗了一位有 ILD 的 NSCLC 患者，这表明需要进一步评估其应用。
