Cao Min, Fu Yujie, Xiao Xiuying, Tang Jian, Tang Daoqiang, Zhao Xiaojing
Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Transl Med. 2020 Dec;8(24):1691. doi: 10.21037/atm-20-7582.
Lung cancer has the highest morbidity and mortality worldwide among the malignant tumors. The treatment of lung cancer was difficult in the decade years. Currently, the advent of immune checkpoint inhibitors (ICIs) has changed the pattern of lung cancer treatment. Programmed death-ligand 1 (PD-L1) inhibitors, such as pembrolizumab, plus platinum-based chemotherapy is the preferred treatment modality for advanced or metastatic non-small cell lung cancer (NSCLC) patients. The success of pembrolizumab in lung cancer has increased interest in expanding the use of neoadjuvant treatment. Immune-related adverse events (irAEs) are the most common adverse reactions in immunotherapy. The balance between the benefits and risks is crucial in this setting. Video-assisted thoracoscopic surgery (VATS) is a routine procedure of resectable NSCLC treatment. It appears to favor low postoperative complication rate. The prolonged air leakage (PAL) is the most common complication after VATS, and the bronchopleural fistula (BPF) is the most serious complication. The management of adverse events after VATS, especially in the setting of immune therapy, need to be raised. Here, we report a case of BPF following VATS lobectomy, which firstly presented the treatment-related adverse event with neoadjuvant combination therapy of pembrolizumab plus cisplatin/pemetrexed. Literature on novel neoadjuvant immunotherapy was also reviewed in the present study.
在全球范围内，肺癌在恶性肿瘤中发病率和死亡率最高。在过去十年里，肺癌的治疗颇具难度。目前，免疫检查点抑制剂（ICI）的出现改变了肺癌的治疗模式。程序性死亡配体1（PD-L1）抑制剂，如帕博利珠单抗，联合铂类化疗是晚期或转移性非小细胞肺癌（NSCLC）患者的首选治疗方式。帕博利珠单抗在肺癌治疗中的成功引发了人们对扩大新辅助治疗应用的兴趣。免疫相关不良事件（irAE）是免疫治疗中最常见的不良反应。在此情况下，权衡利弊至关重要。电视辅助胸腔镜手术（VATS）是可切除NSCLC治疗的常规手术。它似乎有利于降低术后并发症发生率。长时间漏气（PAL）是VATS术后最常见的并发症，而支气管胸膜瘘（BPF）是最严重的并发症。VATS术后不良事件的管理，尤其是在免疫治疗背景下，需要引起重视。在此，我们报告1例VATS肺叶切除术后发生BPF的病例，该病例首次呈现了帕博利珠单抗联合顺铂/培美曲塞新辅助联合治疗相关的不良事件。本研究还对新型新辅助免疫治疗的文献进行了综述。
