Shen Jiahui, Wen Zhongyong, Lin Jingxia, Su Huiwen
Gynaecology of The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China.
Front Pharmacol. 2023 Feb 23;14:1094844. doi: 10.3389/fphar.2023.1094844. eCollection 2023.
Ovarian cancer is one of the deadliest gynecological cancers, with the most advanced disease and poor survival. Although BRCA genes play a key role in maintaining genomic stability and providing the possibility of clinically individualized treatments, with the emergence of new and more appropriate treatment options, new treatment-related adverse events are challenging and difficult for clinicians. An 80-year-old Chinese woman was diagnosed with stage IIIC ovarian high-grade serous adenocarcinoma (CT3cN1MX) with BRCA2 as the causative gene. She underwent three courses of neoadjuvant chemotherapy with nab-paclitaxel 400 mg and carboplatin 450 mg before surgery. Chest HRCT prior to chemotherapy demonstrated bilateral interstitial pneumonia. During chemotherapy, there were four episodes of dry cough, shortness of breath, dyspnea, and three episodes of bone marrow suppression. The symptoms became intermittent and progressively worse, and after three sessions of empirical cough and phlegm relief, oxygen inhalation, corticosteroids, anti-infectives, and leukopenia therapy, the symptoms became intermittent and progressively worse. The diagnosis of idiopathic pulmonary fibrosis came a week after the third round of chemotherapy. After a strong dose of corticosteroids and nintedanib anti-fibrosis therapy, the pulmonary symptoms abated, and intermediate tumor starvation was performed. The combination therapy was subsequently discontinued, and the patient experienced significant relief from pulmonary symptoms. Treatment response was positive following single-agent nab-paclitaxel 400 mg chemotherapy in combination with nintedanib 150 mg anti-fibrosis therapy. In this report, we describe a rare case of idiopathic pulmonary fibrosis associated with the use of nab-paclitaxel and carboplatin in ovarian cancer. During treatment, it is necessary to maintain a high level of vigilance for patients with interstitial pneumonia and engage the attention of clinicians to improve medication safety. Early diagnosis and anti-fibrosis therapy can reverse lung damage.
卵巢癌是最致命的妇科癌症之一,疾病进展至最晚期且生存率低。尽管BRCA基因在维持基因组稳定性及提供临床个体化治疗可能性方面发挥关键作用,但随着更新、更合适治疗方案的出现,新的治疗相关不良事件对临床医生来说具有挑战性且棘手。一名80岁中国女性被诊断为伴有BRCA2致病基因的IIIC期卵巢高级别浆液性腺癌(CT3cN1MX)。她在手术前行三个疗程的新辅助化疗,使用白蛋白结合型紫杉醇400mg及卡铂450mg。化疗前胸部HRCT显示双侧间质性肺炎。化疗期间,出现4次干咳、气短、呼吸困难,以及3次骨髓抑制。症状呈间歇性且逐渐加重,在进行三个疗程的经验性止咳化痰、吸氧、使用糖皮质激素、抗感染及白细胞减少治疗后,症状仍呈间歇性且逐渐加重。在第三轮化疗后一周确诊为特发性肺纤维化。在给予大剂量糖皮质激素及尼达尼布抗纤维化治疗后,肺部症状减轻,随后进行了中间性肿瘤减灭术。联合治疗随后停用,患者肺部症状明显缓解。白蛋白结合型紫杉醇400mg单药化疗联合尼达尼布150mg抗纤维化治疗后治疗反应呈阳性。在本报告中,我们描述了一例罕见的与卵巢癌使用白蛋白结合型紫杉醇和卡铂相关的特发性肺纤维化病例。治疗期间,对于间质性肺炎患者有必要保持高度警惕,并引起临床医生的重视以提高用药安全性。早期诊断及抗纤维化治疗可逆转肺损伤。