Pu Dan, Zhang Hong-E, Li Lu
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Transl Lung Cancer Res. 2024 Aug 31;13(8):2043-2049. doi: 10.21037/tlcr-24-461. Epub 2024 Aug 17.
Chemotherapy combined with immunotherapy is currently the standard first-line treatment for advanced small-cell lung cancer (SCLC). Immunotherapy can induce specific adverse events, called immune-related adverse events (irAEs). IrAEs of bones have rarely been reported. However, identifying bone irAEs could be important in avoiding misdiagnosis and ensuring appropriate patient management. This is the first report describing the diagnosis of irAEs of osteoblastic bone changes mimicking bone metastasis in a SCLC patient treated with durvalumab.
In this report, we describe a unique and challenging case in which a 54-year-old female patient with SCLC treated with durvalumab, an immunotherapy drug, exhibited osteoblastic bone changes that appeared similar to bone metastasis on imaging but were actually a side effect of immunotherapy. Before treatment, imaging revealed no bone metastasis. In the third month after treatment with durvalumab, computed tomography (CT) revealed multiple bone alterations, predominantly osteoblastic lesions with minor osteolytic changes. Various imaging tests suggested bone metastasis, but she had no symptoms related to bone disease. Notably, the lesions in the chest had achieved a partial response. Based on a comprehensive analysis of the CT-guided pathological biopsy results, the patient's symptoms, and the biological characteristics of SCLC, we determined that these bone changes were irAEs occurring in the skeletal system. The patient was followed up for 10 months, during which time the bone lesions remained stable.
IrAEs of bones are rare, and their manifestations vary. Sometimes, the imaging manifestations of bone irAEs are difficult to distinguish from bone metastasis. If patients show variable treatment responses between different lesions, careful evaluation (including a pathological biopsy) is necessary.
化疗联合免疫疗法目前是晚期小细胞肺癌（SCLC）的标准一线治疗方法。免疫疗法可诱发特定的不良事件，称为免疫相关不良事件（irAEs）。骨骼的irAEs鲜有报道。然而，识别骨骼irAEs对于避免误诊和确保患者得到适当管理可能很重要。这是第一份描述在用度伐利尤单抗治疗的SCLC患者中，诊断模仿骨转移的成骨性骨改变的irAEs的报告。
在本报告中，我们描述了一个独特且具有挑战性的病例，一名54岁接受免疫疗法药物度伐利尤单抗治疗的SCLC女性患者，出现了成骨性骨改变，在影像学上看似与骨转移相似，但实际上是免疫疗法的副作用。治疗前，影像学检查未发现骨转移。在用度伐利尤单抗治疗后的第三个月，计算机断层扫描（CT）显示多处骨骼改变，主要是成骨病变，伴有轻微的溶骨改变。各种影像学检查提示骨转移，但她没有与骨病相关的症状。值得注意的是，胸部病变已实现部分缓解。基于对CT引导下病理活检结果、患者症状和SCLC生物学特征的综合分析，我们确定这些骨骼改变是发生在骨骼系统的irAEs。对该患者进行了10个月的随访，在此期间骨病变保持稳定。
骨骼的irAEs很少见，其表现各异。有时，骨骼irAEs的影像学表现难以与骨转移区分开来。如果患者在不同病变之间表现出不同的治疗反应，则需要仔细评估（包括病理活检）。
