Deng Juan, Chen Xiaoxia, Sun Hui, Liu Yu, Li Wei, Chen Bin, Zhao Sha, Jia Keyi, Wang Hao, Guo Haoyue, Jiang Minlin, Xu Yi, He Yayi, Zhou Caicun
Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.
Tongji University, Shanghai, China.
Ann Transl Med. 2020 Jul;8(14):889. doi: 10.21037/atm-20-4980.
Immunotherapy has changed the pattern of treatment in cancer. The interaction between programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibits the activation of T cells, and PD-1/PD-L1 inhibitors can increase the immune response to cancer cells by inducing the immune cells, which has become an important clinical method to treat cancer. However, the alteration in the activation of T cells might lead to misidentification between the body's own cells and tumor cells and induce immune-related adverse events (IRAEs), such as pneumonitis, liver dysfunction, rash, colitis, nephritis, and endocrinopathies. And the IRAEs might lead to serious consequences. Studies have reported that PD-1/PD-L1 inhibitor-related hepatotoxicity is one of these adverse events. Most of the studies reported that hepatitis resulting from PD-1 inhibitor was manifested as elevated liver enzymes and bilirubin. Quite a few patients experienced lower degree of hepatotoxicity treated with checkpoint inhibitors, which indicated that it was necessary to focus on immunotherapy-related liver dysfunction. Here, we report a case of immunotherapy-related liver dysfunction with hypoproteinemia as the first manifestation under the treatment of PD-1 inhibitors combined with chemotherapy. This case suggests that hypoproteinemia was one of the manifestations of immunotherapy-related liver dysfunction, which helps us better understand the immunotherapy-related disease.
免疫疗法改变了癌症的治疗模式。程序性死亡受体1（PD-1）与程序性死亡配体1（PD-L1）之间的相互作用会抑制T细胞的激活，而PD-1/PD-L1抑制剂可通过诱导免疫细胞来增强对癌细胞的免疫反应，这已成为治疗癌症的一种重要临床方法。然而，T细胞激活的改变可能会导致机体自身细胞与肿瘤细胞之间的误识别，并引发免疫相关不良事件（IRAEs），如肺炎、肝功能障碍、皮疹、结肠炎、肾炎和内分泌病。而且这些免疫相关不良事件可能会导致严重后果。研究报告称，PD-1/PD-L1抑制剂相关的肝毒性就是这些不良事件之一。大多数研究报告称，PD-1抑制剂所致肝炎表现为肝酶和胆红素升高。不少接受检查点抑制剂治疗的患者出现了程度较低的肝毒性，这表明有必要关注免疫疗法相关的肝功能障碍。在此，我们报告1例在PD-1抑制剂联合化疗治疗下以低蛋白血症为首发表现的免疫疗法相关肝功能障碍病例。该病例提示低蛋白血症是免疫疗法相关肝功能障碍的表现之一，这有助于我们更好地理解免疫疗法相关疾病。
