免疫检查点抑制剂治疗非小细胞肺癌引起相关肺炎的临床分析  

Clinical analysis of pneumonitis caused by immune checkpoint inhibitors in treatment of non-small cell lung cancer

作　　者：马丽云 闫春良[1] 赵秋红[1] 任喜艳 郑清月 MALiyun;YAN Chunliang;ZHAO Qiuhong;REN Xiyan;ZHENG Qingyue(Department of Respiratory Medicine,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院呼吸内科,北京1000760

出　　处：《癌症进展》2021年第8期810-813,共4页Oncology Progress

摘　　要：目的分析晚期非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICI)治疗后发生免疫检查点抑制剂相关肺炎(CIP)的临床特点。方法收集接受ICI治疗的125例晚期NSCLC患者的临床资料,分析发生CIP患者的临床特征、CIP发生时间、严重程度、影像学表现、治疗及转归情况。结果125例患者应用ICI治疗,7例(5.6%)患者出现CIP。发生CIP的患者中,2级CIP 4例(57.1%),3级CIP 3例(42.9%);发生时间为免疫治疗后1天至69周,中位发生时间为27周。7例(100%)患者出现CIP临床表现,其中喘息7例,咳嗽5例,发热3例,咯血2例。胸部CT影像学表现:双肺磨玻璃影5例,双肺斑片影3例,斑片影合并网格影2例,双肺实变影3例。7例患者接受了激素治疗,激素治疗后6例患者病情好转,1例患者无好转,经激素联合托珠单抗治疗后好转。无CIP导致的死亡病例。治疗好转后4例患者停用免疫治疗,3例患者再次接受ICI治疗。结论NSCLC患者接受ICI治疗后可发生CIP,CIP虽然是一种少见且严重的不良事件,但经及时发现、合理治疗后,大多预后良好,部分患者可尝试再次接受ICI治疗。Objective To analyze the clinical characteristics of checkpoint inhibitor pneumonitis(CIP)in advanced non-small cell lung cancer(NSCLC)patients treated with immune checkpoint inhibitor(ICI).Method Clinical data of 125 patients with advanced NSCLC treated with ICI were collected.The clinical characteristics of CIP,onset time of CIP,severity,imaging manifestations,treatment and outcome of CIP were analyzed.Result There were 7 CIP patients(5.6%)among 125 patients treated with ICI,with 4 patients(57.1%)of grade 2 CIP,3 patients(42.9%)of grade 3 CIP.The CIP occurred at median of 27 weeks(ranged from 1 day to 69 weeks)after immunotherapy.7 patients(100%)showed clinical manifestations of CIP,with 7 cases of shortness of breath,5 cases of cough,3 cases of fever and 2 cases of hemoptysis.CT imaging findings showed there were 5 cases of ground glasses,3 cases of patchy shadows,2 cases of patchy shadows combined with grid shadows,3 cases of consolidation shadow.7 patients received hormone therapy,the condition of 6 patients improved and 1 patient not improved(improved after hormone+Tocilizumab).No CIP deaths occurred.After improvement,4 patients discontinued the immunotherapy,and 3 patients rechallenged with immunotherapy.Conclusion CIP may occur after treatment with ICI in NSCLC patients,and CIP caused by ICI is a relatively rare but potentially severe adverse event.The prognosis is generally better after prompt diagnosis and adequate treatment,and some patients can try to receive ICI rechallenge treatment.

关 键 词：免疫检查点抑制剂 免疫检查点抑制剂相关肺炎 非小细胞肺癌 晚期 

分 类 号：R734.2[医药卫生—肿瘤]