Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea.
Division of Hematology-Oncology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea.
Medicina (Kaunas). 2023 Feb 9;59(2):325. doi: 10.3390/medicina59020325.
In patients with renal failure and hemodialysis, there are difficulties in drug selection and dose adjustment for cancer treatment. The use of immune checkpoint inhibitors (ICIs), including pembrolizumab, approved by the U.S. Food and Drug Administration (FDA) for patients with metastatic non-small cell lung cancer (NSCLC) in 2015, has become an important option for the treatment of metastatic NSCLC. However, data regarding the dosage and schedule for long-term use of ICIs, especially pembrolizumab, in hemodialysis patients are limited. We present the case of a patient with metastatic squamous NSCLC who demonstrated a long-term partial response to pembrolizumab monotherapy for 45 months during hemodialysis and showed no immune-related adverse events (irAEs). To our knowledge, this is the longest remission to be reported without irAEs after discontinuation of pembrolizumab in a NSCLC patient undergoing HD. In addition, we reviewed previously reported lung cancer patients who used ICI during dialysis, comparing them with our case in clinical aspect. We believe that this report will provide clinical insights into the long-term efficacy and safety of pembrolizumab in lung cancer patients undergoing hemodialysis.
在肾衰竭和血液透析的患者中，癌症治疗存在药物选择和剂量调整方面的困难。2015 年，美国食品药品监督管理局（FDA）批准免疫检查点抑制剂（ICIs），包括 pembrolizumab，用于治疗转移性非小细胞肺癌（NSCLC）患者，这已成为转移性 NSCLC 治疗的重要选择。然而，关于长期使用 ICI（特别是 pembrolizumab）在血液透析患者中的剂量和方案的数据有限。我们报告了一例转移性鳞状 NSCLC 患者的病例，该患者在血液透析期间接受 pembrolizumab 单药治疗 45 个月，表现出长期部分缓解，且无免疫相关不良事件（irAEs）。据我们所知，这是在接受 HD 的 NSCLC 患者停止 pembrolizumab 治疗后报告的无 irAEs 最长缓解期。此外，我们回顾了先前报道的在透析期间使用 ICI 的肺癌患者，并将其与我们的病例在临床方面进行了比较。我们相信，该报告将为血液透析肺癌患者使用 pembrolizumab 的长期疗效和安全性提供临床见解。
