Zhang Zhang, Uemura Takehiro, Guo Pengyi
Department of Rheumatology, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Transl Cancer Res. 2025 Feb 28;14(2):1500-1505. doi: 10.21037/tcr-2024-2364. Epub 2025 Feb 26.
Immune checkpoint inhibitors (ICIs) have proven efficacious in various types of cancers, including lung cancer, but they usually lead to a set of organ-specific immune-related adverse events (irAEs). In particular, checkpoint inhibitor pneumonitis (CIP) requires special attention because it is difficult to diagnose and can be potentially fatal. Accumulating real-world epidemiological data indicate that CIP is more common than previously reported. Amyopathic dermatomyositis (ADM), which shows no or minimal muscle damage, is positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5) and involves unique skin findings, as well as clinical features of rapidly progressive interstitial lung disease (RP-ILD). Therefore, knowing how to differentiate between CIP and ADM-related RP-ILD is important, which can provide valuable experience for subsequent treatment of patients.
We report a case of a patient with stage IV lung adenocarcinoma who developed ADM associated with RP-ILD following the administration of pembrolizumab, an inhibitor of the programmed cell death 1 (PD-1) pathway. The principal adverse reactions to pembrolizumab are irAEs. However, pembrolizumab-associated ADM has not been previously reported in clinical settings. The patient presented with atypical skin lesions and tested positive for anti-MDA5 antibodies, accompanied by severe acute ILD.
We believe this case represents a valuable clinical reference for the future management of irAEs caused by pembrolizumab and emphasizes the necessity of early screening for anti-melanoma differentiation associated protein 5 (MDA5) antibodies in patients with CIP presenting as RP-ILD.
免疫检查点抑制剂（ICIs）已被证明在包括肺癌在内的多种癌症中有效，但它们通常会导致一系列器官特异性免疫相关不良事件（irAEs）。特别是，检查点抑制剂肺炎（CIP）需要特别关注，因为它难以诊断且可能致命。越来越多的真实世界流行病学数据表明，CIP比以前报道的更为常见。无肌病性皮肌炎（ADM）无或仅有轻微肌肉损伤，抗黑色素瘤分化相关基因5（抗MDA5）呈阳性，具有独特的皮肤表现以及快速进展性间质性肺病（RP-ILD）的临床特征。因此，了解如何区分CIP和ADM相关的RP-ILD很重要，这可为后续患者治疗提供宝贵经验。
我们报告一例IV期肺腺癌患者，在使用程序性细胞死亡蛋白1（PD-1）通路抑制剂帕博利珠单抗后发生了与RP-ILD相关的ADM。帕博利珠单抗的主要不良反应是irAEs。然而，帕博利珠单抗相关的ADM此前在临床环境中尚未有报道。该患者出现非典型皮肤病变，抗MDA5抗体检测呈阳性，并伴有严重的急性ILD。
我们认为该病例为未来管理帕博利珠单抗引起的irAEs提供了有价值的临床参考，并强调对于表现为RP-ILD的CIP患者早期筛查抗黑色素瘤分化相关蛋白5（MDA5）抗体的必要性。
