Department of Respiratory Medicine, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda City, Shizuoka Province, Japan.
Department of Pathology, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda City, Shizuoka Province, Japan.
BMC Pulm Med. 2021 Jan 6;21(1):6. doi: 10.1186/s12890-020-01375-5.
Immune checkpoint inhibitors have potential applications in treating various cancers but are associated with immune-related adverse events, such as inflammation, in a wide range of organs; however, allergic inflammation caused by these agents has not been extensively studied.
A 65-year-old man was diagnosed with a kidney neuroendocrine carcinoma. Three months after kidney resection surgery, the tumor cells had metastasized to his liver and lymph nodes. Subsequently, the patient started chemotherapy; however, regardless of treatment, the tumor grew, and the patient experienced a series of adverse effects, such as taste disorder, anorexia, and general fatigue. Finally, he was administered a programmed cell death (PD)-1 inhibitor, nivolumab (biweekly, toal 200 mg/body), which was effective against kidney carcinoma. However, the patient had a bronchial asthma attack at 22 cycles of nivolumab treatment and chest computed tomography (CT) revealed an abnormal bilateral shadow after 37 cycles of nivolumab treatment. Bronchoscopy findings revealed eosinophil infiltration in the lungs along with severe alveolar hemorrhage. Paranasal sinus CT scanning indicated sinusitis and nerve conduction analysis indicated a decrease in his right ulnar nerve conduction velocity. Based on these findings, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis; he was treated with prednisolone, which alleviated his bronchial asthma. To restart nivolumab treatment, the dose of prednisolone was gradually tapered, and the patient was administered a monthly dose of mepolizumab and biweekly dose of nivolumab. To date, there have been no bronchial attacks or CT scan abnormalities upon follow up.
We present a rare case in which a patient with cancer was diagnosed with eosinophilic granulomatosis with polyangiitis following treatment with a PD-1 inhibitor. Blockade of PD-1 and the programmed cell death ligand (PD-L) 1/PD-1 and PD-L2/PD-1 signaling cascade may cause allergic inflammation. Further studies are needed to identify the specific mechanisms underlying allergic inflammation after PD-1 blockade.
免疫检查点抑制剂在治疗各种癌症方面具有应用潜力，但会引起广泛器官的免疫相关不良反应，如炎症；然而，这些药物引起的过敏炎症尚未得到广泛研究。
一名 65 岁男性被诊断为肾神经内分泌癌。肾切除术 3 个月后，肿瘤细胞转移到他的肝脏和淋巴结。随后，患者开始接受化疗；然而，无论治疗与否，肿瘤都在生长，患者出现一系列不良反应，如味觉障碍、食欲不振和全身乏力。最终，他接受了程序性细胞死亡（PD）-1 抑制剂纳武利尤单抗（每两周一次，总量 200mg/体）治疗，该药物对肾细胞癌有效。然而，在纳武利尤单抗治疗 22 个周期时，患者发生支气管哮喘发作，在纳武利尤单抗治疗 37 个周期后胸部 CT 显示双侧异常阴影。支气管镜检查结果显示肺部嗜酸性粒细胞浸润，伴有严重肺泡出血。副鼻窦 CT 扫描提示鼻窦炎，神经传导分析显示右侧尺神经传导速度下降。根据这些发现，患者被诊断为嗜酸性肉芽肿性多血管炎；他接受了泼尼松龙治疗，缓解了支气管哮喘。为了重新开始纳武利尤单抗治疗，逐渐减少泼尼松龙的剂量，并给予每月一次美泊利珠单抗和每两周一次纳武利尤单抗。迄今为止，在随访中没有出现支气管发作或 CT 扫描异常。
我们报告了一例罕见病例，一名癌症患者在接受 PD-1 抑制剂治疗后被诊断为嗜酸性肉芽肿性多血管炎。PD-1 和程序性死亡配体（PD-L）1/PD-1、PD-L2/PD-1 信号通路的阻断可能引起过敏炎症。需要进一步研究以确定 PD-1 阻断后过敏炎症的具体机制。
