肺癌患者免疫治疗后出现假进展的多学科诊疗  

Multidisciplinary treatment of lung cancer with pseudo-progression after immunotherapy

作　　者：曹木兰 赵明芳[1] Mulan Cao;Mingfang Zhao(Department of Oncology,The First Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属第一医院肿瘤内科,沈阳市110000

出　　处：《中国肿瘤临床》2021年第10期516-520,共5页Chinese Journal of Clinical Oncology

基　　金：国家重点研发计划项目(编号:2016YFC1303800)资助。

摘　　要：目的:探讨多学科协作体系(multidisciplinary treatment,MDT)在肺腺癌免疫治疗中的作用。方法:分析中国医科大学附属第一医院收治的1例程序性细胞死亡蛋白-1(programmed cell death-1,PD-1)抑制剂纳武利尤单抗治疗晚期肺腺癌患者期间发生假性进展及免疫相关不良反应的MDT诊疗过程。结果:患者经多次MDT讨论后行肺部病灶二次穿刺活检,证实为假性进展,辅以肺部局部放疗和抗炎止疼治疗。明确假性进展后继续免疫治疗,病灶达到部分缓解(partial response,PR),而免疫治疗所产生的关节肿痛在对症治疗后消失,并在后续治疗中未再发生。结论:免疫治疗在未来将是肺腺癌重要的治疗手段,如何处理不良反应是临床医生应重点考虑的问题。MDT诊疗模式有利于制定规范化、个体化的治疗方案,探索更有效的肺腺癌治疗方法,使更多的患者受益。Objective:To assess the role of multidisciplinary treatment(MDT)in immunotherapy for lung adenocarcinoma.Methods:The MDT diagnosis and treatment process of a patient with pseudo-progression and immune-related adverse reactions during the treatment of nivolumab,a programmed cell death-1(PD-1)inhibitor,in advanced lung adenocarcinoma in The First Hospital of China Medical University was analyzed.Results:After MDT discussions,the patient underwent a second puncture biopsy of the lung lesion,which was confirmed to be pseudo-progression.In addition,the patient was treated with local pulmonary radiotherapy and anti-inflammatory and analgesic treatment.Immunotherapy continued after pseudo-progression was identified,and effect evaluation revealed partial response(PR)was achieved.Immunotherapy-related joint swelling and pain disappeared after symptomatic treatment and did not recur during the follow-up treatment.Conclusions:Immunotherapy will be an important therapeutic modality for lung adenocarcinoma in the future,and the balance between its efficacy and adverse reactions should be considered by clinicians.Adopting MDT is conducive for formulating standardized and individualized treatment plans and exploring more effective treatment methods for lung adenocarcinoma so that more patients are benefited.

关 键 词：非小细胞肺癌 免疫治疗 假性进展 免疫相关的不良事件 

分 类 号：R734.2[医药卫生—肿瘤]