Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China.
Department of Pathology, The People's Liberation Army, No. 960 Hospital, Jinan, China.
J Cancer Res Ther. 2020;16(7):1555-1559. doi: 10.4103/jcrt.JCRT_971_20.
Immune checkpoint blockade with programmed cell death protein-1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors has been standard care for metastatic nonsmall cell lung cancer (NSCLC) and after progression using first-line platinum-containing chemotherapy. Although several management guidelines exist for immune checkpoint inhibitor-induced toxicities, uncommon, complicated, and life-threatening immune-related adverse events remain challenging for oncologists. In this report, we presented a male patient with NSCLC who received pembrolizumab during disease progression. He developed interstitial pembrolizumab-induced organizing pneumonia (OP). The patient received 9 months of anti-PD-1 pembrolizumab when he presented with dry cough and fatigue. The patient developed a solitary nodular lung lesion mimicking a newly occurred metastatic lesion in the lung without a significant circulating tumor marker increase. Sputum analysis was negative for acid-fast bacilli and fungi. A computed tomography-guided percutaneous lung biopsy was conducted and showed alveolar fibrous thickness and various lymphocyte infiltration. Immunotherapy-related OP was identified, and he subsequently responded well to corticosteroids. This case describes a clinical situation, where PD-1-induced OP is radiologically similar to NSCLC disease progression in the lungs. Oncologists should be aware of uncommon pulmonary PD-1/PD-L1 inhibitor toxicity. Lung biopsy may help to distinguish immune-related pneumonitis, lung infections, and progressive nodular lesions.
免疫检查点阻断剂与程序性死亡蛋白-1（PD-1）/程序性死亡配体-1（PD-L1）抑制剂的联合应用已成为转移性非小细胞肺癌（NSCLC）的标准治疗方法，并且在一线含铂化疗进展后也可使用。尽管存在几种用于免疫检查点抑制剂相关毒性的管理指南，但罕见、复杂且危及生命的免疫相关不良反应仍然对肿瘤学家构成挑战。在本报告中，我们介绍了一位 NSCLC 患者，他在疾病进展期间接受了 pembrolizumab 治疗。他出现了间质性 pembrolizumab 诱导的机化性肺炎（OP）。该患者在出现干咳和疲劳时已接受了 9 个月的抗 PD-1 pembrolizumab 治疗。患者出现孤立性结节状肺病变，类似于肺部新发生的转移性病变，但循环肿瘤标志物增加不明显。痰分析未检出抗酸杆菌和真菌。进行了 CT 引导下经皮肺活检，显示肺泡纤维厚度和各种淋巴细胞浸润。确定了免疫治疗相关 OP，他随后对皮质类固醇反应良好。本病例描述了一种临床情况，即 PD-1 诱导的 OP 在肺部与 NSCLC 疾病进展在影像学上相似。肿瘤学家应注意罕见的肺部 PD-1/PD-L1 抑制剂毒性。肺活检有助于区分免疫相关性肺炎、肺部感染和进行性结节性病变。
