Zecevic Andrej, Blanka-Protic Ana, Jandric Aleksandar, Adzic-Vukicevic Tatjana
Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Pathol Oncol Res. 2025 Mar 14;31:1612022. doi: 10.3389/pore.2025.1612022. eCollection 2025.
Immunotherapy has made a significant improvement in the treatment of patients with non-small cell lung cancer (NSCLC). It has a role in boosting the immune system, so it can fight cancer cells. Sometimes, this mechanism can lead to an overstimulation or misdirection of immune response, so it can act against the body itself. One of the organs most affected by this reaction is the thyroid gland, and there is no definitive explanation of the causes of this adverse event.
In this retrospective observational study, we enrolled 103 patients with NSCLC and high PD-L1 expression (>= 50%) who were treated in our Clinic for pulmonology, University Clinical Center of Serbia, using Pembrolizumab as the first-line therapy.
Data analysis showed that 41 (39.81%) of 103 patients in our study had an adverse event of immunotherapy, and 21 of them had autoimmune thyroiditis (20.39%). Of all the patients, 19 of them were treated for chronic obstructive pulmonary disease (COPD) before the onset of Pembrolizumab. During treatment, eight of these patients developed thyroid dysfunction. Patients with COPD were at increased risk of developing autoimmune thyroiditis compared to non-COPD patients (OR 3.9 95% CI 1.135-13.260, p = 0.0227).
Our study showed that patients dealing with COPD have a 3.9 times greater risk of developing autoimmune thyroiditis as an adverse event during Pembrolizumab treatment compared with patients without COPD.
免疫疗法在非小细胞肺癌（NSCLC）患者的治疗中取得了显著进展。它在增强免疫系统方面发挥作用，因此能够对抗癌细胞。有时，这种机制会导致免疫反应过度刺激或方向错误，从而对身体自身产生作用。受这种反应影响最严重的器官之一是甲状腺，而对于这种不良事件的原因尚无确切解释。
在这项回顾性观察研究中，我们纳入了103例高程序性死亡配体1（PD-L1）表达（>=50%）的非小细胞肺癌患者，这些患者在塞尔维亚大学临床中心肺病科接受派姆单抗作为一线治疗。
数据分析显示，在我们的研究中，103例患者中有41例（39.81%）发生了免疫疗法不良事件，其中21例患有自身免疫性甲状腺炎（20.39%）。在所有患者中，19例在开始使用派姆单抗之前接受过慢性阻塞性肺疾病（COPD）治疗。在治疗期间，这些患者中有8例出现了甲状腺功能障碍。与非慢性阻塞性肺疾病患者相比，慢性阻塞性肺疾病患者发生自身免疫性甲状腺炎的风险增加（比值比3.9，95%置信区间1.135 - 13.260，p = 0.0227）。
我们的研究表明，与没有慢性阻塞性肺疾病的患者相比，患有慢性阻塞性肺疾病的患者在接受派姆单抗治疗期间发生自身免疫性甲状腺炎这种不良事件的风险高3.9倍。
