依维莫司引起的非感染性肺炎1例病例报道及文献复习  

Noninfectious pneumonitis caused by everolimus therapy for recurrent breast cancer: a case report

作　　者：曹璐[1] 陈佳艺[1,2] 

机构地区：[1]复旦大学附属肿瘤医院放射治疗科,复旦大学上海医学院肿瘤学系,上海200032 [2]上海交通大学医学院附属瑞金医院放射治疗科,上海200025

出　　处：《中国新药杂志》2014年第24期2938-2942,2947,共6页Chinese Journal of New Drugs

摘　　要：依维莫司作为一种口服的雷帕霉素靶蛋白抑制剂,可用于激素受体阳性的进展期乳腺癌治疗。非感染性肺炎(NIP)是依维莫司治疗相关的重要不良反应。尽管依维莫司所致NIP通常症状较轻并可控,但是其却是导致依维莫司剂量调整及停药的主要不良反应,甚至可能导致死亡。因此,依维莫司导致的NIP需要及时诊断和治疗。本文报道1例阿那曲唑辅助内分泌治疗9个月后胸壁复发的乳腺癌病例,该患者在服用依维莫司联合依西美坦3个月后出现NIP。该患者的胸部CT表现为两肺内散在斑片影,并出现咳嗽以及轻度呼吸困难。依维莫司减量50%处理后1周,患者的相关症状明显好转。本文对相关文献进行了复习,并对乳腺癌患者中依维莫司所致NIP的诊断、发生率、发生机制及处理原则进行了讨论。Everolimus is an orally administered inhibitor of the mammalian target of rapamycin（mTOR）,which is indicated for advanced hormone receptor-positive breast cancer based on favorable results from phase III clinical trials. Its clinically significant toxicity is the development of noninfectious pneumonitis（NIP）. Although generally mild and manageable,NIP is the main cause of everolimus dose adjustment and even death,and therefore requires prompt diagnosis and management. Herein we presented a case of anadvanced breast cancer patient who developed interstitial pneumonitis 3 months after switching from anastrozole to everolimus combined with exemestane due to local recurrence on the chest wall. The patients developed radiological evidence of NIP in the chest computed tomography（CT） and symptoms such as cough and mild dyspnea. After the dose reduction of everolimus to50% of the initial daily dose（5 mg·d- 1,po）,there was marked remission of symptoms 1 week later. We reviewed the related literatures and discussed the diagnosis,incidence,mechanism,and management of mTOR inhibitors-induced NIP in breast cancer patients.

关 键 词：雷帕霉素靶蛋白抑制剂 依维莫司 非感染性肺炎(NIP) 激素受体阳性 乳腺癌 

分 类 号：R977[医药卫生—药品]