贝伐珠单抗联合紫杉醇治疗非小细胞肺癌过程中并发支气管胸膜瘘1例报告及文献复习  

Bronchopleural fistula complicated in treatment process of nonsmall cell lung cancer by bevacizumab combined with paclitaxel:A case report and literature review

作　　者：侯俊杰[1,2] 米旭光 李孝男 李晓男[2] 杨影 江显卓[1] 周颖 倪志强[1] 金宁一[2,3] 方艳秋 HOU Junjie;MI Xuguang;LI Xiaonan;LI Xiaonan;YANG Ying;JIANG Xianzhuo;ZHOU Ying;NI Zhiqiang;JIN Ningyi;FANG Yanqiu(Department of Comprehensive Oncology,Jilin Province People’s Hospital,Changchun 130021,China;Department of Pathophysiology,School of Medical Sciences,Yanbian University,Yanji 133002,China;Laboratory of Molecular Virology and Immunology,Academy of Military Medical Sciences,Changchun 130122,China)

机构地区：[1]吉林省人民医院肿瘤综合治疗科,吉林长春130021 [2]延边大学医学院病理生理学教研室,吉林延吉133002 [3]军事医学科学院分子病毒学与免疫学实验室,吉林长春130122

出　　处：《吉林大学学报（医学版）》2022年第2期513-517,共5页Journal of Jilin University：Medicine Edition

基　　金：吉林省卫健委卫生与健康科技创新项目(2020J109)。

摘　　要：目的:探讨贝伐珠单抗联合紫杉醇(白蛋白结合型)治疗非小细胞肺癌(NSCLC)过程中并发支气管胸膜瘘(BPF)发生的可能机制、临床表现和预防策略,及时鉴别出具有潜在风险的个体患者,为BPF的预防提供参考。方法:收集1例贝伐珠单抗联合紫杉醇(白蛋白结合型)治疗NSCLC过程中并发BPF患者的临床资料,复习及归纳相关文献,总结出其发生的潜在风险。结果:患者,男性,62岁,局部晚期肺腺癌(驱动基因阴性),接受贝伐珠单抗和紫杉醇(白蛋白结合)后线化疗,经过2个周期的化疗后,患者的临床症状和功能状态均有所改善,但并发急性BPF及继发胸腔内感染,被迫停止抗血管生成治疗和化疗,虽经过胸腔闭式引流、积极抗感染治疗和最佳支持治疗等,临床症状未能得到缓解,患者最终于2019年9月17日死于呼吸衰竭。结论:当病变同时侵及胸膜、气管和胸壁,且贝伐珠单抗联合化疗治疗过程中出现肿瘤空化效应或治疗前病变已存在癌腔时,应警惕诱发急性BPF。由于急性BPF缺乏有效的预防和治疗措施,因此及时识别出具有潜在风险的个体患者对预后至关重要。Objective:To investigate the possible mechanism,clinical manifestations and prevention strategies of bronchopleural fistula(BPF)complicated in the treatment of non-small cell lung cancer(NSCLC)by bevacizumab combined with paclitaxel(albumin-binding type),and to identify the individuals with potential risk in time,and to provide the reference for the prevention of this disease.Methods:The clinical data of one patient with bronchopleural fistula(BPF)complicated in the treatment of NSCLC by bevacizumab combined with paclitaxel(albumin binding type)were collected,and the relevant literatures were reviewed and the potential risk of occurrence was summarized.Results:A 62-year-old male patient with locally advanced lung adenocarcinoma(negative drive gene)was administered with bevacizumab and paclitaxel(albumin bound)chemotherapy.After 2 cycles of chemotherapy,the patient’s clinical symptoms and functional status were improved.However,due to acute BPF and secondary intrathoracic infection,the patient was forced to stop anti-angiogenic therapy and chemotherapy.Although closed thoracic drainage,active anti-infection treatment and optimal supportive treatment were performed,the clinical symptoms were not relieved.The patient died of respiratory failure on September 17,2019.Conclusion:Acute BPF should be induced when the lesions invades pleura,trachea and chest wall simultaneously,and the tumor cavitation effect occurred during the treatment of bevacizumab combined with chemotherapy or the tumor cavity existed in the lesions before treatment.Due to the lack of effective prevention and treatment measures for acute BPF,timely identification of the individual patients with potential risks is crucial to the prognosis.

关 键 词：贝伐珠单抗 支气管胸膜瘘 癌 非小细胞肺 抗血管生成 化疗 

分 类 号：R734.2[医药卫生—肿瘤]