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喉癌伴肺转移在停用纳武单抗后显示长期完全缓解及延迟的免疫相关不良事件

Laryngeal Cancer With Lung Metastases Showing Long-Term Complete Response and Delayed Immune-Related Adverse Event After Nivolumab Discontinuation.

作者信息

Kondo Takahito, Nakatsugawa Munehide, Okubo Mitsuru, Nakamura Hironori, Yunaiyama Daisuke, Wakiya Midori, Takeda Atsuo, Kikawada Naiue, Kishida Takuma, Someya Miwako, Yoshida Shigekazu, Ogawa Yasuo, Tsukahara Kiyoaki

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Tatemachi, Tokyo, Japan.

Department of Pathology, Tokyo Medical University Hachioji Medical Center, Tatemachi, Tokyo, Japan.

出版信息

Ear Nose Throat J. 2025 Apr;104(4):222-227. doi: 10.1177/01455613211031025. Epub 2021 Jul 19.

Abstract

We report a case of laryngeal cancer with multiple lung metastases that maintained a complete response (CR) for 18 months after discontinuing nivolumab treatment, with colitis developing 5 months after drug discontinuation. A 65-year-old man was diagnosed with T3N2cM0 stage IVA right supraglottic squamous cell carcinoma that progressed after 1 course of TPF (cisplatin, docetaxel, and 5-fluorouracil) as induction chemotherapy. He underwent total laryngectomy, bilateral neck dissection, pharyngeal reconstruction with anterolateral thigh flap, and creation of a permanent tracheostoma; extranodal extension was detected in the right cervical lymph node metastasis, and the patient underwent adjuvant radiotherapy. Multiple lung metastases occurred during radiotherapy, and the patient was deemed platinum refractory; nivolumab treatment was thus initiated. The tumor proportion score for programmed death-ligand 1-evaluated via antibody testing of the laryngeal tumor-was <1. The patient received 240 mg/body nivolumab every 2 weeks; a computed tomography performed after course 16 of nivolumab treatment confirmed a CR. He exhibited grade 2 thyroid dysfunction, grade 1 interstitial pneumonia, and grade 2 colitis after 6, 7, and 14 months of receiving nivolumab, respectively; treatment was discontinued as despite maintaining a CR, interstitial pneumonia occurred twice. Colitis appeared 5 months after nivolumab discontinuation; nevertheless, a CR was maintained after 18 months.

摘要

我们报告一例喉癌伴多发肺转移患者,停用纳武单抗治疗后维持完全缓解(CR)达18个月,停药5个月后发生结肠炎。一名65岁男性被诊断为IVA期右声门上鳞状细胞癌,T3N2cM0,诱导化疗1疗程TPF(顺铂、多西他赛和5-氟尿嘧啶)后病情进展。他接受了全喉切除术、双侧颈清扫术、用股前外侧皮瓣进行咽部重建以及永久性气管造口术;在右颈淋巴结转移中检测到结外扩展,患者接受了辅助放疗。放疗期间出现多发肺转移,患者被认为对铂类耐药;因此开始纳武单抗治疗。通过喉肿瘤抗体检测评估的程序性死亡配体1的肿瘤比例评分<1。患者每2周接受240mg/体的纳武单抗治疗;纳武单抗治疗第16疗程后进行的计算机断层扫描证实为CR。接受纳武单抗治疗6、7和14个月后,他分别出现2级甲状腺功能障碍、1级间质性肺炎和2级结肠炎;尽管维持CR,但间质性肺炎发生了两次,因此停止治疗。纳武单抗停药5个月后出现结肠炎;然而,18个月后仍维持CR。

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