Zhou Haojie, Tan Lijie, Shen Yaxing, Jun Yin, Liu Tianshu, Ai Luoyan
Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China.
J Thorac Dis. 2024 Nov 30;16(11):8110-8116. doi: 10.21037/jtd-24-227. Epub 2024 Nov 29.
Immune checkpoint inhibitors (ICIs) are emerging as important drugs for patients with locally advanced esophageal cancer (EC). Yet, immune-related adverse events (irAEs) may be a major obstacle for these population. Multidisciplinary team (MDT) is an efficient way to deal with such conditions. The aim of this study is to report a case of a stage III esophageal squamous cell carcinoma (ESCC) patient who achieved long-term survival through comprehensive treatment and MDT management, despite multiple irAEs.
A 67-year-old man was diagnosed with stage III ESCC (cT4N1M0) in January 2021. After 2 cycles of initial immuno-chemotherapy with good efficiency, he suffered from grade 3 immune-related hepatitis (IRH) and recovered after steroid therapy. Then radical radiotherapy began as planned. However, he got pneumonia and common antibiotics and steroid showed no effect. Finally, NGS-based pathogen detection identified cytomegalovirus (CMV) infection in his sputum. Ganciclovir was prescribed to him and his condition turned better soon. During a five-month period of anti-infectious therapy and follow-up, there was no anti-tumor treatment. However, the patient's esophageal lesion was evaluated as having a partial response (PR) on computed tomography (CT) scan and cancer cells transformed to high-grade intraepithelial neoplasia through gastroscopy. He underwent endoscopic submucosal dissection (ESD) and began a five-month follow-up period. When dysplasia recurred locally, the MDT members carefully restarted ICIs since he had fully recovered from previous irAEs and we believed he benefited from long-term responses to ICIs. Despite experiencing a third irAE, that is, adrenocortical insufficiency with mild symptoms, the patient still greatly benefited from ICIs. After being diagnosed as stage III EC for about 35 months, the patient's disease was still evaluated as clinical no evidence of disease (NED).
EC patients with irAEs who are well managed benefited from ICIs. MDT is crucial in the management of comprehensive treatment for EC.
免疫检查点抑制剂（ICIs）正成为局部晚期食管癌（EC）患者的重要药物。然而，免疫相关不良事件（irAEs）可能是这类人群的主要障碍。多学科团队（MDT）是应对此类情况的有效方式。本研究的目的是报告一例III期食管鳞状细胞癌（ESCC）患者，尽管发生了多种irAEs，但通过综合治疗和MDT管理实现了长期生存。
一名67岁男性于2021年1月被诊断为III期ESCC（cT4N1M0）。在进行了2个周期初始免疫化疗且疗效良好后，他出现了3级免疫相关肝炎（IRH），经类固醇治疗后康复。随后按计划开始根治性放疗。然而，他患上了肺炎，普通抗生素和类固醇治疗均无效。最终，基于二代测序（NGS）的病原体检测在他的痰液中发现了巨细胞病毒（CMV）感染。给他开了更昔洛韦，他的病情很快好转。在抗感染治疗和随访的五个月期间，未进行抗肿瘤治疗。然而，患者的食管病变在计算机断层扫描（CT）上评估为部分缓解（PR），并且通过胃镜检查癌细胞转变为高级别上皮内瘤变。他接受了内镜黏膜下剥离术（ESD）并开始了五个月的随访期。当局部发育异常复发时，MDT成员在他已从先前的irAEs中完全康复且我们认为他会从ICIs的长期反应中获益后，谨慎地重新开始使用ICIs。尽管经历了第三次irAE，即症状较轻的肾上腺皮质功能不全，但患者仍从ICIs中大大获益。在被诊断为III期EC约35个月后，患者的疾病仍被评估为临床无疾病证据（NED）。
管理良好的有irAEs的EC患者从ICIs中获益。MDT在EC的综合治疗管理中至关重要。
