Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
Munakata Yasuhiko Clinic, Sendai, Miyagi, Japan.
Cancer Rep (Hoboken). 2024 Jul;7(7):e2145. doi: 10.1002/cnr2.2145.
The expansion of preoperative immunochemotherapy has led to an increase in the number of patients with lung cancer receiving immune checkpoint inhibitors (ICIs). Therefore, oncologists should manage a variety of immune-related adverse events (irAEs). One of the rare, life-threatening, and recently proposed irAEs is cytokine release syndrome (CRS). Although the standard treatment of irAE is systemic administration of steroids, it has been suggested that tocilizumab may be an effective treatment option for CRS.
This case describes a 69-year-old man with stage IIIA lung adenocarcinoma who received chemotherapy and nivolumab, which is an ICI, as neoadjuvant immunochemotherapy. After the first administration, the patient developed severe skin rash, fever, and arthralgia. We suspected irAEs and administered systemic steroids. However, fever and arthralgia did not improve, although the skin rash disappeared. These were also significant challenges for surgery. Noting the elevated levels of inflammatory cytokines, we consulted a rheumatologist. Finally, we decided to terminate neoadjuvant therapy after one cycle and administer tocilizumab. Tocilizumab dramatically improved the patient's symptoms and allowed him to undergo radical surgery. Pathological findings revealed that the patient achieved a major pathological response.
This indicates the potential effectiveness of early tocilizumab administration for ICI-induced CRS, even in mild cases.
术前免疫化疗的扩展导致越来越多的肺癌患者接受免疫检查点抑制剂（ICI）治疗。因此，肿瘤学家应管理各种免疫相关不良事件（irAE）。细胞因子释放综合征（CRS）是一种罕见的、危及生命的、最近提出的 irAE。虽然 irAE 的标准治疗是全身给予类固醇，但有人提出托珠单抗可能是 CRS 的有效治疗选择。
本例为一名 69 岁男性，患有 IIIA 期肺腺癌，接受了新辅助免疫化疗，包括化疗和纳武利尤单抗（一种 ICI）。首次给药后，患者出现严重皮疹、发热和关节痛。我们怀疑发生了 irAE，并给予全身类固醇治疗。然而，发热和关节痛并未改善，尽管皮疹已消失。这也对手术造成了很大的挑战。鉴于炎症细胞因子水平升高，我们咨询了风湿病专家。最终，我们决定在一个周期后停止新辅助治疗，并给予托珠单抗治疗。托珠单抗显著改善了患者的症状，使其能够接受根治性手术。病理检查结果显示患者达到了主要病理缓解。
这表明即使在轻度病例中，早期给予托珠单抗治疗 ICI 诱导的 CRS 可能具有潜在疗效。
