Li Qian, Liu Mei, Liu Yunxia, Shi Feng, Yuan Shan, Di Guojie, Jin Haobin, Shi Yaru, Zhang Wen, Yang Zhe
Qingdao Jiaozhou Central Hospital, Qingdao, PR China.
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China.
Case Rep Oncol. 2024 Jun 19;17(1):673-680. doi: 10.1159/000538429. eCollection 2024 Jan-Dec.
Although programmed death ligand 1 (PD-L1) inhibitor plus chemotherapy regimen is a promising strategy for malignant tumors, it can induce significant immune-related adverse events, such as immune-related pneumonitis. Here, we report the first case of lethal immune-related pneumonitis in an Asian patient receiving anti-PD-L1 treatment.
A 68-year-old man was diagnosed with small cell lung cancer and interstitial pneumonia. After his pulmonary infection was relieved by comprehensive treatment, the patient received first-line treatment with durvalumab plus etoposide and carboplatin. Two weeks after starting durvalumab treatment, the patient had chest pain and shortness of breath. He was diagnosed with immune-induced pneumonia and treated with methylprednisolone, cefoperazone, and sulbactam, followed by oxygen and pirfenidone. Oxygen partial pressure decreased to 58 mm Hg within next the 4 days and laboratory assessment suggested cytokine storm. The patient underwent 2 plasma exchanges, one double filtration plasmapheresis and oxygen saturation decreased continuously. The patient died 1 month after durvalumab treatment.
Immune-related pneumonitis induced by PD-L1 inhibitors is rare but life-threatening. Infection should be ruled out before starting immunotherapy.
尽管程序性死亡配体1（PD-L1）抑制剂联合化疗方案是治疗恶性肿瘤的一种有前景的策略，但它可引发显著的免疫相关不良事件，如免疫相关性肺炎。在此，我们报告首例接受抗PD-L1治疗的亚洲患者发生致命性免疫相关性肺炎的病例。
一名68岁男性被诊断为小细胞肺癌和间质性肺炎。在通过综合治疗缓解肺部感染后，该患者接受了度伐利尤单抗联合依托泊苷和卡铂的一线治疗。开始度伐利尤单抗治疗两周后，患者出现胸痛和气短。他被诊断为免疫性肺炎，并接受了甲泼尼龙、头孢哌酮和舒巴坦治疗，随后使用了氧气和吡非尼酮。在接下来的4天内，氧分压降至58mmHg，实验室评估提示细胞因子风暴。患者接受了2次血浆置换、1次双重滤过血浆置换，且血氧饱和度持续下降。患者在度伐利尤单抗治疗1个月后死亡。
PD-L1抑制剂引起的免疫相关性肺炎虽罕见但危及生命。在开始免疫治疗前应排除感染。
