Zhu Yan, Yu Jianhe, Ren Qun, Wu Xiang, Xu Hongxia, Tian Tian, Liu Jiang
Department of Oncology, Dongtai Hospital of Traditional Chinese Medicine, Dongtai, Jiangsu, China.
Department of Oncology, The Affiliated Xinghua People's Hospital, Medical School of Yangzhou University, Xinghua, Jiangsu, China.
Front Immunol. 2024 Nov 22;15:1454114. doi: 10.3389/fimmu.2024.1454114. eCollection 2024.
The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment landscape for tumor patients, dramatically improving survival rate. However, patients treated with immunotherapy are inevitably at risk of immune-related adverse events (irAEs). Immune checkpoint inhibitor-related pneumonitis (ICI-P) is an important type of IrAEs with a potentially lethal risk, which should be given more attention. Diagnosis and timely treatment of ICI-P is challenging due to the lack of specificity of its clinical and radiological features. Besides, poor understanding of biological mechanisms of ICI-P has led to a lack of reliable biomarkers to identify patients at risk, limiting timely treatment and proper management of it.
We presented longitudinal clinical features and successful treatment experience in a metastatic esophageal squamous cell carcinoma (ESCC) patient treated with immunochemotherapy followed by palliative radiotherapy for cervical lymph nodes who developed severe pneumonitis outside of the radiation field ten days after completion of radiotherapy suggestive of ICI-P. In addition, analysis of circulating biomarkers demonstrated an increase in platelet-to-lymphocyte ratio (PLR) and platelet-to-monocyte ratio (PMR), as well as the levels of CD4T and CD8T cells that tracked with the progression of ICI-P, and then decreased with corticosteroid treatment.
Our data highlight the imaging manifestations associated with ICI-related pulmonary toxicity and describe the dynamics of the corresponding circulating markers. Although our results reveal that dynamic monitoring of PLR and PMR as well as the levels of CD4T and CD8T cells may predict the risk of ICI-P, further investigations are needed to elucidate the underlying molecular and biological mechanisms for better management of ICI-P.
免疫检查点抑制剂（ICI）的出现彻底改变了肿瘤患者的治疗格局，显著提高了生存率。然而，接受免疫治疗的患者不可避免地面临免疫相关不良事件（irAE）的风险。免疫检查点抑制剂相关肺炎（ICI-P）是一种重要的irAE类型，具有潜在致命风险，应予以更多关注。由于其临床和放射学特征缺乏特异性，ICI-P的诊断和及时治疗具有挑战性。此外，对ICI-P生物学机制的了解不足导致缺乏可靠的生物标志物来识别有风险的患者，限制了对其的及时治疗和妥善管理。
我们展示了一名转移性食管鳞状细胞癌（ESCC）患者的纵向临床特征和成功治疗经验。该患者接受免疫化疗，随后对颈部淋巴结进行姑息性放疗，放疗结束十天后在放疗野外发生严重肺炎，提示为ICI-P。此外，对循环生物标志物的分析表明，血小板与淋巴细胞比值（PLR）和血小板与单核细胞比值（PMR）增加，以及CD4T和CD8T细胞水平随ICI-P进展而变化，然后随着皮质类固醇治疗而下降。
我们的数据突出了与ICI相关肺部毒性相关的影像学表现，并描述了相应循环标志物的动态变化。虽然我们的结果显示动态监测PLR和PMR以及CD4T和CD8T细胞水平可能预测ICI-P的风险，但需要进一步研究以阐明潜在的分子和生物学机制，以便更好地管理ICI-P。
