Wang Huan, Jin Yuzhen, Liu Peng, Zhou Jie, Fan Na, Li Mengjie
Department of Oncology, Cangzhou Fifth Hospital (People's Hospital of Qingxian), Cangzhou, China.
Department of Respiratory and Critical Care Medicine, Cangzhou Fifth Hospital (People's Hospital of Qingxian), Cangzhou, China.
BMC Pulm Med. 2024 Dec 2;24(1):597. doi: 10.1186/s12890-024-03424-9.
Checkpoint inhibitor-related pneumonitis (CIP) is a rare but serious complication of immune checkpoint inhibitors (ICIs). While it typically occurs within the first few months of treatment, its onset after ICI discontinuation is relatively uncommon. This report presents a case of CIP occurring 2.5 months after cessation of pembrolizumab and reviews the existing literature on CIP after discontinuation of ICIs.
A 77-year-old female with stage IV right lung adenocarcinoma (T4N2M1a) developed pneumonitis 2.5 months after discontinuation of pembrolizumab (following 26 months of initial treatment). Initially suspected as community-acquired pneumonia, the patient received antiviral and antibiotic therapy with progressive deterioration. Microbiological investigations yielded negative results, and consultation suggested lung cancer recurrence. PET-CT revealed heightened metabolic activity in the lungs. Percutaneous lung biopsy demonstrated organizing pneumonia, and NGS testing of biopsy tissue showed no pathogenic organisms. Combined with CT findings and the patient's history of pembrolizumab use, the diagnosis of checkpoint inhibitor-related pneumonitis (CIP) was established. Short-term steroid therapy resulted in significant improvement.
Integration of clinical presentation, imaging findings, and medication history is crucial for diagnosis. This case underscores the need for vigilance for CIP even after discontinuing ICI therapy. Although this report provides insights into CIP after discontinuation based on a single case and a literature review, further studies involving larger cohorts are warranted to better understand the post-treatment risk of CIP.
检查点抑制剂相关肺炎（CIP）是免疫检查点抑制剂（ICI）罕见但严重的并发症。虽然它通常发生在治疗的最初几个月内，但在ICI停药后发病相对少见。本报告介绍了1例在帕博利珠单抗停药2.5个月后发生CIP的病例，并回顾了关于ICI停药后CIP的现有文献。
一名77岁的IV期右肺腺癌（T4N2M1a）女性在帕博利珠单抗停药2.5个月后（初始治疗26个月后）发生肺炎。最初怀疑为社区获得性肺炎，患者接受抗病毒和抗生素治疗，但病情逐渐恶化。微生物学检查结果为阴性，会诊提示肺癌复发。PET-CT显示肺部代谢活性增强。经皮肺活检显示机化性肺炎，活检组织的NGS检测未发现致病微生物。结合CT表现及患者使用帕博利珠单抗的病史，确诊为检查点抑制剂相关肺炎（CIP）。短期类固醇治疗后病情明显改善。
综合临床表现、影像学表现和用药史对诊断至关重要。该病例强调即使在停止ICI治疗后也需要警惕CIP。尽管本报告基于单个病例和文献综述对停药后CIP进行了分析，但仍需要开展涉及更大队列的进一步研究，以更好地了解CIP的治疗后风险。
