State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151#Yanjiang Road, Guangzhou, 510120, China.
BMC Pulm Med. 2024 Nov 21;24(1):577. doi: 10.1186/s12890-024-03258-5.
Immune checkpoint inhibitor-related pneumonitis (CIP) stands out as a particularly severe adverse event caused by immune checkpoint inhibitors, with a substantial real-world incidence ranging from 13 to 19%. While systemic corticosteroids represent the standard treatment for CIP, therapeutic options become limited in cases where patients do not respond to corticosteroid therapy. Such patients are classified as having steroid-resistant CIP, often associated with a poor prognosis. This case study provides insight into the symptoms, diagnostic process, and treatment approach for steroid-resistant CIP. Notably, successful management is demonstrated through the utilization of cyclosporine, highlighting its potential mechanisms of action in effectively treating steroid-resistant CIP.
We present the case of a 53-year-old male with stage IV. A non-small cell lung cancer (NSCLC), who experienced elevated fever, cough, and dyspnea subsequent to immunotherapy treatment. Based on his medical history, clinical manifestations, and radiological findings, the patient was diagnosed with CIP. Initial administration of led to improvement, but during the subsequent tapering of corticosteroid therapy, a resurgence of CIP occurred, resulting in respiratory failure. Consequently, we arrived at the diagnosis of steroid-resistant CIP, prompting the implementation of a combination therapy with cyclosporine and corticosteroids to establish stable disease control. Upon systematic reduction of corticosteroid dosage, the patient maintained a favorable response with no recurrence.
This marks the first instance of effectively managing steroid-resistant CIP through the combined use of cyclosporine and corticosteroids. Presently, cases of steroid-resistant CIP remain infrequent, necessitating vigilant and meticulous monitoring within clinical settings. Notably, there exists no distinct guideline specifying a singular agent for rescuing patients unresponsive to corticosteroid therapy. Therefore, cyclosporine emerges as a promising and efficacious treatment alternative for individuals unresponsive to corticosteroid intervention in the context of CIP.
免疫检查点抑制剂相关肺炎（CIP）是免疫检查点抑制剂引起的一种特别严重的不良反应，其真实世界的发生率在 13%至 19%之间。虽然全身性皮质类固醇是 CIP 的标准治疗方法，但如果患者对皮质类固醇治疗无反应，治疗选择就会受到限制。这些患者被归类为皮质类固醇耐药性 CIP，通常预后不良。本病例研究提供了对皮质类固醇耐药性 CIP 的症状、诊断过程和治疗方法的深入了解。值得注意的是，环孢素的成功应用证明了其在有效治疗皮质类固醇耐药性 CIP 方面的潜在作用机制。
我们报告了一名 53 岁男性的病例，他患有 IV 期非小细胞肺癌（NSCLC）。在免疫治疗后，他出现了发热、咳嗽和呼吸困难。根据他的病史、临床表现和影像学发现，患者被诊断为 CIP。最初使用皮质类固醇治疗后有所改善，但在随后的皮质类固醇减量过程中，CIP 再次发作，导致呼吸衰竭。因此，我们诊断为皮质类固醇耐药性 CIP，并采用环孢素和皮质类固醇联合治疗以控制疾病。在系统性减少皮质类固醇剂量后，患者病情稳定，无复发。
这是首例通过联合使用环孢素和皮质类固醇成功治疗皮质类固醇耐药性 CIP 的病例。目前，皮质类固醇耐药性 CIP 的病例仍然很少见，因此在临床环境中需要进行警惕和细致的监测。值得注意的是，目前没有明确的指南规定单一药物用于治疗对皮质类固醇治疗无反应的患者。因此，环孢素在 CIP 中对皮质类固醇干预无反应的患者是一种有前途且有效的治疗选择。
