度伐利尤单抗致免疫相关性肺炎1例  

A case of immune-related pneumonia induced by durvalumab

作　　者：谭飞龙 夏洪颖[1] 王重娟 李燕华[1] 周丽 徐虹[1] 游丽娜 TAN Fei-long;XIA Hong-ying;WANG Zhong-juan;LI Yan-hua;ZHOU Li;XU Hong;YOU Li-na(Department of Pharmacy,the Affiliated Yan'an Hospital of Kunming Medical University,Kunming 650051,China)

机构地区：[1]昆明医科大学附属延安医院药学部,云南昆明650051

出　　处：《中国药物应用与监测》2023年第2期139-142,共4页Chinese Journal of Drug Application and Monitoring

基　　金：国家自然科学基金资助项目(82060744)。

摘　　要：1例77岁男性患者,确诊左肺腺癌6个月余。于2022年1月7日给予AP方案化疗[培美曲塞(800 mg,d1)+卡铂(400 mg,d1),q 3 w]6次,疗效评价为部分缓解(PR)。2022年5月20日调整为度伐利尤单抗500 mg,d1,q 2 w免疫治疗,疗效评价:维持PR。2022年8月9日患者出现咳嗽、咯痰,伴乏力、纳差,行胸部CT检查提示:双肺间质性改变,双肺下叶少量纤维条索灶,双侧胸腔大量积液,结合临床治疗史及实验室检查,除外特殊感染和药物损伤可能。考虑为度伐利尤单抗所致免疫相关性肺炎,停用度伐利尤单抗,给予甲泼尼龙琥珀酸钠(40 mg,qd,ivgtt)治疗,3 d后患者咳嗽、咯痰症状较前明显缓解,将激素调整为醋酸泼尼松片(50 mg,qd)治疗。7 d后复查肺部CT示双肺下叶纤维条索灶消失,双侧胸腔积液基本吸收,此后激素逐渐减量至停用。3个月后电话随访,患者症状已完全好转。A 77-year-old male patient who diagnosed with left lung adenocarcinoma for more than 6 months was treated with a AP chemotherapy regimen(pemetrexed 800 mg,d1 and carboplatin 400 mg,d1,q 3 w)for 6 cycles with partial response(PR).On May 20th 2022,durvalumab(500 mg,d1,q 2 w)was given to him for maintenance treatment and the efficacy evaluation was still PR.And then he had cough,expectoration,fatigue and poor appetite on August 9th 2022.The chest CT scan showed interstitial changes in bilateral lung,a small amount of fibrous strip lesions in lower lobes of bilateral lung,and a large amount of effusion in bilateral pleural cavity,which was suggested immune-related pneumonia induced by durvalumab after excluding uncommon infection and drug injury combined with the medical history and laboratory examination.Durvalumab was discontinued and methylprednisolone sodium succinate(40 mg,qd,ivgtt)was given to him.Three days later,the cough and expectoration were significantly relieved,and methylprednisolone sodium succinate was adjusted to prednisone acetate tablets(50 mg,qd).Seven days later,the chest CT scan indicated that bilateral lower lobe fibrous cord lesions disappeared,bilateral pleural effusion was basically absorbed.Prednisone acetate tablets was gradually reduced to drug withdrawal.Three months later,the patient completely improved in telephone follow-up.

关 键 词：度伐利尤单抗 免疫相关性肺炎 药品不良反应 临床药师 

分 类 号：R969.3[医药卫生—药理学] R979.1[医药卫生—药学]