Posado-Domínguez Luis, Escribano-Iglesias María, Bellido-Hernández Lorena, León-Gil Johana Gabriela, Gómez-Muñoz María Asunción, Gómez-Caminero López Felipe, Martín-Galache María, Inés-Revuelta Sandra M, Fonseca-Sánchez Emilio
Medical Oncology Department, University Hospital of Salamanca, 37007 Salamanca, Spain.
Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
Curr Oncol. 2024 Nov 18;31(11):7319-7329. doi: 10.3390/curroncol31110540.
: Anti PD1/PD-L1 agents, including pembrolizumab, have revolutionized the oncological treatment of different types of cancer, including non-small cell lung cancer. The most frequent complications associated with this type of treatment are mild and are located at the thyroid, pulmonary or hepatic level. Sarcoid like reaction and mesenteric panniculitis secondary to pembrolizumab treatment are two very rare adverse effects. We present the case of a patient with these complications. : the treatment of metastatic non-small cell lung cancer has undergone a major change in the last 10 years, largely due to the advent of immunotherapy. Anti PD1 agents such as pembrolizumab have increased the median survival of these patients from 13 to 26 months. Most frequent immunorelated side effects are hypothyroidism, pneumonitis or elevated liver enzymes. However, there are other adverse effects, including sarcoid-like reaction and mesenteric panniculitis, which should be known by the professionals involved in the diagnosis and treatment of this type of patient. We present the case of a 62-year-old man with a history of unresectable and non-irradiable stage IIIB epidermoid lung carcinoma with a PD-L1 expression of 30% in whom pembrolizumab was discontinued after 4 cycles due to immunorelated arthritis. One year later he consulted for severe abdominal pain. A PET-CT scan was performed, showing hilar lymphadenopathy and inflammation of abdominal mesenteric fat. A biopsy of lesions in both areas showed non-necrotizing granulomatous lymphadenitis in hilar adenopathy and patchy fibrosis of mesenteric fat. The picture was classified as sarcoidosis-like reaction and mesenteric panniculitis secondary to pembrolizumab. Anti-PD1 agents cause hyperactivation of the immune system through T-cell proliferation. Sarcoid-like reaction is a very rare complication that can mask progressive tumor disease. Awareness of immunorelated complications by oncologists, internists, and radiologists is important for an appropriate diagnostic approach and targeted test ordering.
抗程序性死亡蛋白1（PD1）/程序性死亡配体1（PD-L1）药物，包括帕博利珠单抗，已经彻底改变了包括非小细胞肺癌在内的不同类型癌症的肿瘤治疗方式。与这类治疗相关的最常见并发症较为轻微，发生在甲状腺、肺部或肝脏层面。帕博利珠单抗治疗继发的结节病样反应和肠系膜脂膜炎是两种非常罕见的不良反应。我们报告一例出现这些并发症的患者。：在过去10年中，转移性非小细胞肺癌的治疗发生了重大变化，这在很大程度上归因于免疫疗法的出现。诸如帕博利珠单抗之类的抗PD1药物已将这些患者的中位生存期从13个月提高到26个月。最常见的免疫相关副作用是甲状腺功能减退、肺炎或肝酶升高。然而，还有其他不良反应，包括结节病样反应和肠系膜脂膜炎，参与这类患者诊断和治疗的专业人员应该了解这些情况。我们报告一例62岁男性患者，有不可切除且不可放疗的IIIB期表皮样肺癌病史，PD-L1表达为30%，因免疫相关关节炎在4个周期后停用帕博利珠单抗。一年后，他因严重腹痛前来就诊。进行了正电子发射断层扫描（PET-CT），显示肺门淋巴结肿大和腹部肠系膜脂肪炎症。对这两个部位病变的活检显示，肺门淋巴结病为非坏死性肉芽肿性淋巴结炎，肠系膜脂肪为斑片状纤维化。该病例被归类为帕博利珠单抗继发的结节病样反应和肠系膜脂膜炎。抗PD1药物通过T细胞增殖导致免疫系统过度激活。结节病样反应是一种非常罕见的并发症，可能掩盖肿瘤进展性疾病。肿瘤学家、内科医生和放射科医生了解免疫相关并发症对于采取适当的诊断方法和有针对性地开具检查至关重要。
