Nigen B, Chéné A-L, Liberge R, Sagan C, Blanc F-X
Service de pneumologie, institut du thorax, CHU de Nantes, Nantes université, Nantes, France.
Service de pneumologie, institut du thorax, CHU de Nantes, Nantes université, Nantes, France.
Rev Mal Respir. 2022 Sep;39(7):626-632. doi: 10.1016/j.rmr.2022.07.001. Epub 2022 Jul 15.
Immune checkpoint inhibitors have revolutionized the management of many cancers and achieved efficacy and durable response for some patients, including those with advanced cancers. However, immunotherapy is associated with side effects caused by the infiltration of immune cells into normal tissues, which can lead to disproportionate dysimmune reactions. While mostly of moderate intensity, these side effects can affect any organ, including the lung, the site of occasionally life-threatening interstitial lung disease. Their presentation can be similar to that of infectious pneumonia (COVID-19).
We report the cases of 3 patients who presented between March and May 2020 with severe pulmonary toxicities secondary to immunotherapy, which led to with an initial hypothesis of SARS-CoV-2 pneumonia. After extensive investigations, the diagnosis of pulmonary toxicity to immunotherapy was given, and the clinical and radiological course following the initiation of corticosteroid therapy was favorable.
Pulmonary toxicity secondary to immunotherapy remains a rare but potentially life-threatening side effect. The diagnostic approach requires the elimination of several differential diagnoses (infectious process, tumor progression, other etiologies of interstitial lung disease). This adverse event is reversible and evolution after initiation of corticosteroid therapy is usually favorable.
免疫检查点抑制剂彻底改变了许多癌症的治疗方式，使一些患者（包括晚期癌症患者）获得了疗效和持久反应。然而，免疫疗法会引发免疫细胞浸润正常组织所导致的副作用，进而可能引发不成比例的免疫反应失调。虽然这些副作用大多强度适中，但可影响任何器官，包括肺部，偶尔会引发危及生命的间质性肺病。其表现可能与感染性肺炎（新型冠状病毒肺炎）相似。
我们报告了3例于2020年3月至5月期间出现免疫疗法继发严重肺部毒性反应的患者病例，最初推测为新型冠状病毒肺炎。经过广泛检查后，确诊为免疫疗法所致肺部毒性反应，皮质类固醇治疗开始后的临床和影像学病程良好。
免疫疗法继发的肺部毒性反应仍然是一种罕见但可能危及生命的副作用。诊断方法需要排除多种鉴别诊断（感染性病程、肿瘤进展、间质性肺病的其他病因）。这种不良事件是可逆的，皮质类固醇治疗开始后的病情演变通常良好。
