Kunogi Yasuhito, Tominaga Keiichi, Abe Keiichiro, Kanazawa Mimari, Tanaka Takanao, Watanabe Shoko, Kondo Masayuki, Kanamori Akira, Iijima Makoto, Goda Kenichi, Nozawa Yumi, Ishida Kazuyuki, Irisawa Atsushi
Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan.
Department of Diagnostics Pathology, Dokkyo Medical University, Tochigi 321-0293, Japan.
Healthcare (Basel). 2021 Apr 5;9(4):418. doi: 10.3390/healthcare9040418.
Immune checkpoint inhibitors (ICIs) increase T-cell activity and antitumor immune response. However, they also have immune-related adverse effects that can affect the gastrointestinal (GI) tract. A 62-year-old male patient who had undergone right lung upper lobectomy for adenocarcinoma of the lung received chemotherapy with pemetrexed sodium hydrate, carboplatin, and pembrolizumab to prevent postoperative recurrence of liver metastasis. However, the patient experienced severe diarrhea four months after the start of chemotherapy. Although a corticosteroid and two biological preparations were administered to alleviate the diarrhea, no improvement was observed. Eventually, remission was achieved when tacrolimus was administered. Treatment with corticosteroids is recommended for patients with GI adverse effects of ICIs. Rapid introduction of infliximab is necessary for refractory patients. Nevertheless, for refractory cases such as that of our patient, for whom even this regimen is inefficacious, tacrolimus might be recommended to induce remission as with cases of ulcerative colitis.
免疫检查点抑制剂（ICIs）可增强T细胞活性和抗肿瘤免疫反应。然而，它们也会产生免疫相关的不良反应，可能影响胃肠道（GI）。一名62岁男性患者因肺腺癌接受了右肺上叶切除术，术后接受培美曲塞二钠、卡铂和帕博利珠单抗化疗以预防肝转移复发。然而，化疗开始四个月后，该患者出现了严重腹泻。尽管给予了皮质类固醇和两种生物制剂以缓解腹泻，但未见改善。最终，给予他克莫司后病情缓解。对于ICIs引起胃肠道不良反应的患者，建议使用皮质类固醇进行治疗。对于难治性患者，需要迅速使用英夫利昔单抗。然而，对于像我们患者这样的难治性病例，即使这种治疗方案也无效，可能推荐使用他克莫司来诱导缓解，就像溃疡性结肠炎病例一样。
