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帕博利珠单抗诱发晚期肺鳞状细胞癌患者发生史蒂文斯-约翰逊综合征:一例报告并文献复习

Pembrolizumab-induced Stevens-Johnson syndrome in advanced squamous cell carcinoma of the lung: A case report and review of literature.

作者信息

Wu Jing-Yi, Kang Kai, Yi Jing, Yang Bin

机构信息

Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan 430000, Hubei Province, China.

Department of Thoracic Oncology Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei Province, China.

出版信息

World J Clin Cases. 2022 Jun 26;10(18):6110-6118. doi: 10.12998/wjcc.v10.i18.6110.

Abstract

BACKGROUND

For advanced lung squamous cell carcinoma, immune checkpoint inhibitors (ICIs) have been regarded as one of the optimal therapies. While immune-related adverse events (irAEs) are common in ICI treatment, cutaneous toxicities are among the most common irAEs. Most immune-related skin toxicity grades are low, and the prognosis is good. However, Stevens-Johnson syndrome (SJS) is a rare but extremely severe cutaneous adverse drug reaction with high mortality.

CASE SUMMARY

We report a rare case of SJS induced by pembrolizumab. The case involved a 68-year-old female who was diagnosed with advanced squamous cell carcinoma of the lung. SJS appeared after one cycle of immunotherapy combined with chemotherapy. After treatment with prednisone hormone symptoms, anti-infection, gamma globulin, and antipruritic agents, the skin toxicity of the patients gradually decreased and eventually disappeared. Although the antitumor treatment was stopped due to serious adverse reactions, the tumor of the patient remained stable for nearly half a year after one cycle of immune therapy combined with chemotherapy, which also corroborates the delayed effect of immunotherapy.

CONCLUSION

We believe our report can provide some references for the treatment of SJS and the treatment of immune-related adverse reactions.

摘要

背景

对于晚期肺鳞状细胞癌,免疫检查点抑制剂(ICIs)已被视为最佳治疗方法之一。虽然免疫相关不良事件(irAEs)在ICI治疗中很常见,但皮肤毒性是最常见的irAEs之一。大多数免疫相关皮肤毒性等级较低,预后良好。然而,史蒂文斯-约翰逊综合征(SJS)是一种罕见但极其严重的皮肤药物不良反应,死亡率很高。

病例摘要

我们报告了一例由帕博利珠单抗引起的罕见SJS病例。该病例为一名68岁女性,被诊断为晚期肺鳞状细胞癌。在免疫治疗联合化疗一个周期后出现SJS。经泼尼松激素症状治疗、抗感染、丙种球蛋白和止痒剂治疗后,患者的皮肤毒性逐渐减轻并最终消失。尽管由于严重不良反应停止了抗肿瘤治疗,但在免疫治疗联合化疗一个周期后,患者的肿瘤仍稳定了近半年,这也证实了免疫治疗的延迟效应。

结论

我们认为我们的报告可为SJS的治疗及免疫相关不良反应的治疗提供一些参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6869/9254208/b2923ac3b3bb/WJCC-10-6110-g001.jpg

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