Chen Zhujun, He Jian
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Army Medical University, Chongqing, China.
Transl Cancer Res. 2022 Sep;11(9):3309-3314. doi: 10.21037/tcr-22-1162.
Infliximab has been recommended by the American Society of Clinical Oncology (ASCO) guidelines for the treatment of steroid-refractory immune checkpoint inhibitor-related pneumonia (CIP), but clinical evidence remains insufficient. In order to improve the level of diagnosis and treatment and rational use of infliximab in the treatment of CIP, a successful case is reported and the relevant literature is reviewed.
We report a 67-year-old male patient with small cell lung cancer (SCLC) who was admitted to hospital with rapidly worsening dyspnea and bilateral interstitial lung following PD-1 inhibitor (tislelizumab) combined with chemotherapy and radiation therapy. According to the comprehensive judgment of the patient's medical history, clinical symptoms, imaging manifestations, laboratory tests, exclusion of infection, heart failure and treatment response, the diagnosis of grade 4 CIP was made. The patient's condition did not improve after high-dose glucocorticoid and immunoglobulin therapy. After infliximab was added, the clinical manifestations and imaging were significantly improved, oxygenation index also gradually return to normal, then the patient was discharged smoothly.
This report suggests that infliximab should be considered when high-dose glucocorticoids combined with immunoglobulin are ineffective for severe CIP. At the same time, this case indicates that inflammatory factors, especially tumor necrosis factor (TNF-α), may be prospective in predicting the efficacy of infliximab in the treatment of steroid-refractory CIP.
美国临床肿瘤学会（ASCO）指南推荐英夫利昔单抗用于治疗类固醇难治性免疫检查点抑制剂相关肺炎（CIP），但临床证据仍不充分。为提高CIP治疗中英夫利昔单抗的诊断、治疗水平及合理应用，现报告1例成功病例并复习相关文献。
我们报告1例67岁男性小细胞肺癌（SCLC）患者，在接受程序性死亡受体1（PD-1）抑制剂（替雷利珠单抗）联合化疗及放疗后，因呼吸困难迅速加重和双侧间质性肺病入院。根据患者病史、临床症状、影像学表现、实验室检查、排除感染、心力衰竭及治疗反应综合判断，诊断为4级CIP。高剂量糖皮质激素和免疫球蛋白治疗后患者病情未改善。加用英夫利昔单抗后，临床表现及影像学明显改善，氧合指数也逐渐恢复正常，随后患者顺利出院。
本报告提示，当高剂量糖皮质激素联合免疫球蛋白治疗重症CIP无效时，应考虑使用英夫利昔单抗。同时，该病例表明炎症因子，尤其是肿瘤坏死因子（TNF-α），可能在预测英夫利昔单抗治疗类固醇难治性CIP疗效方面具有前瞻性。
