纳武利尤单抗二线免疫治疗晚期恶性胸膜间皮瘤1例  

A case of second-line immunotherapy for advanced malignant pleural mesothelioma with nivolumab

作　　者：吕梦辰 孙娴雯[1] 曾然 杨锦 陈巍[1,2] 罗丽凤[1,3] 汤葳 高蓓莉[1,2] 项轶 Lyu Mengchen;Sun Xianwen;Zeng Ran;Yang Jin;Chen Wei;Luo Lifeng;Tang Wei;Gao Beili;Xiang Yi(Department of Pulmonary and Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Institute of Respiratory Diseases,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Respiratory Disease,Kashgar Prefecture Second People’s Hospital,Kashi 844000,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025 [2]上海交通大学医学院呼吸病研究所,上海200025 [3]新疆喀什地区第二人民医院,喀什844000

出　　处：《中华转移性肿瘤杂志》2022年第4期331-335,共5页Chinese Journal of Metastatic Cancer

基　　金：国家自然基金面上项目(81672271);国家重点研发计划(2018YFC1311900)

摘　　要：患者女,47岁,因"反复左侧胸痛5个月,咳嗽1月余"入院,于2019年12月25日行CT下经皮肺穿刺,病理确诊符合恶性胸膜间皮瘤上皮型。遂于2020年1月8日始行一线培美曲塞、卡铂化疗联合贝伐珠单抗治疗6个周期,培美曲塞联合贝伐珠单抗维持治疗9个周期,无进展生存期为16个月,最佳疗效评估为部分缓解(PR)。2021年5月病情进展二线纳武利尤单抗治疗4个周期,2个周期后疗效评估为PR,8月23日评估再次确认病情缓解。同时发现低氧,CT检查双肺弥漫性间质性肺炎表现。排除感染性肺炎后确诊为免疫检查点抑制剂相关性肺炎(CIP)3级。暂缓免疫治疗,给予甲泼尼龙激素治疗,5 d后病情缓解,激素逐渐减量,6周后CIP完全吸收好转,拟重启免疫治疗。The patient,female,47 years old,was admitted to the hospital due to"recurrent left chest pain for 5 months and cough for more than a month".On December 25,2019,percutaneous lung puncture under CT was performed.The pathological diagnosis was consistent with malignant pleural mesothelioma epithelial type.Then,on January 8,2020,first-line pemetrexed,carboplatin chemotherapy combined with bevacizumab for 6 cycles,pemetrexed combined with bevacizumab maintenance therapy for 9 cycles,progress-free survival time was 16 months,with the best efficacy assessment partial remission(PR).In May 2021,the disease progressed and the second-line nivolumab was treated for 4 cycles.The efficacy evaluation was PR after 2 cycles,and the disease remission was reconfirmed by the evaluation on August 23.At the same time,hypoxia and diffuse interstitial pneumonia in both lungs by CT examination were found.Checkpoint inhibitor-related pneumonitis(CIP)grade 3 was diagnosed after excluding infectious pneumonia.The immunotherapy was suspended,and methylprednisolone hormone therapy was given.After 5 days,the condition remission hormone was gradually reduced.After 6 weeks,the CIP was completely absorbed and improved,and the immunotherapy was planned to be restarted.

关 键 词：恶性胸膜间皮瘤/免疫治疗 纳武利尤单抗 治疗结果 免疫检查点抑制剂相关性肺炎 

分 类 号：R73[医药卫生—肿瘤]