Rahnea-Nita Roxana-Andreea, Stoian Alexandru-Rares, Anghel Rodica-Maricela, Rebegea Laura-Florentina, Ciuhu Anda-Natalia, Bacinschi Xenia-Elena, Zgura Anca-Florina, Trifanescu Oana-Gabriela, Toma Radu-Valeriu, Constantin Georgiana Bianca, Rahnea-Nita Gabriela
The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
"Sf. Luca" Chronic Disease Hospital, 041915 Bucharest, Romania.
Life (Basel). 2023 May 30;13(6):1279. doi: 10.3390/life13061279.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia in cancer patients, occurring most frequently in patients with small cell lung cancer. However, this syndrome occurs extremely rarely in patients with non-small cell lung cancer. The results of the clinical trials have revealed that immuno-oncological therapies are effective for long periods of time, providing hope for long survival and with a good quality of life.
We present the case of a female patient who was 62 years old at the time of diagnosis in 2016 who underwent surgery for a right pulmonary tumor (pulmonary adenocarcinoma) and subsequently underwent adjuvant chemotherapy. The patient had a left inoperable mediastinohilar relapse in 2018, which was treated using polychemotherapy The patient also had an occurrence of progressive metastasis and a syndrome of inappropriate antidiuretic hormone secretion (SIADH) in 2019 for which immunotherapy was initiated. The patient has continued with immunotherapy until the time this study began to be written (April 2023), the results being the remission of hyponatremia, the clinical benefits and long-term survival.
The main therapeutic option for SIADH in cancer patients is the treatment of the underlying disease, and its correction depends almost exclusively on a good response to oncological therapy. The initiation of immunotherapy at the time of severe hyponatremia occurrence led to its remission as well as the remission of the other two episodes of hyponatremia, which the patient presented throughout the evolution of the disease, demonstrating an obvious causal relationship between SIADH and the favorable response to immunotherapy.
Each patient must be approached individually, taking into account the various particular aspects. Immunotherapy proves to be the innovative treatment that contributes to increasing the survival of patients with metastatic non-small cell lung cancer and to increasing their quality of life.
抗利尿激素分泌不当综合征（SIADH）是癌症患者低钠血症最常见的原因，最常发生于小细胞肺癌患者。然而，该综合征在非小细胞肺癌患者中极为罕见。临床试验结果表明，免疫肿瘤疗法具有长期疗效，为患者长期生存及良好生活质量带来了希望。
我们报告一例女性患者，2016年确诊时62岁，因右肺肿瘤（肺腺癌）接受手术，随后接受辅助化疗。2018年患者出现左侧纵隔肺门不可切除的复发，采用多药化疗进行治疗。2019年患者出现进行性转移及抗利尿激素分泌不当综合征（SIADH），遂开始免疫治疗。该患者持续接受免疫治疗直至本研究开始撰写之时（2023年4月），结果为低钠血症缓解、临床获益及长期生存。
癌症患者SIADH的主要治疗选择是治疗基础疾病，其纠正几乎完全取决于对肿瘤治疗的良好反应。在严重低钠血症发生时开始免疫治疗，导致其缓解，以及患者在疾病发展过程中出现的另外两次低钠血症发作也得到缓解，这表明SIADH与对免疫治疗的良好反应之间存在明显的因果关系。
必须针对每个患者进行个体化治疗，考虑到各种特殊情况。免疫治疗被证明是一种创新疗法，有助于提高转移性非小细胞肺癌患者的生存率并改善其生活质量。
