1例帕博利珠单抗致严重免疫性肝毒性患者重启免疫治疗案例分享及启示  

One case study of a patient with severe immune hepatotoxicity due to pembrolizumab and a resumption of immunotherapy:sharing and inspiration

作　　者：李蒙[1] 蓝高爽[1] 袁恒杰[1] 李正翔[1] LI Meng;LAN Gaoshuang;YUAN Hengjie;LI Zhengxiang(Department of Pharmacy,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院药剂科,天津300052

出　　处：《中国医院药学杂志》2024年第19期2308-2310,共3页Chinese Journal of Hospital Pharmacy

摘　　要：男性患者65岁,诊断为右肺恶性肿瘤,伴肺门和腹腔淋巴结转移、骨转移、肾上腺继发性恶性肿瘤。于2021年3月给予两周期“帕博利珠单抗200 mg+培美曲塞0.8 g+卡铂0.5 g”免疫联合化疗方案,出现4级严重免疫性肝毒性,后停用帕博利珠单抗,给予糖皮质激素及保肝治疗,肝功能逐渐恢复正常。2022年5月再次给予三周期“帕博利珠单抗200 mg+培美曲塞0.8 g”免疫联合化疗方案,患者再次出现2级中度肝损伤,经糖皮质激素及保肝治疗后肝功能再次恢复正常。A 65-year-old male patient was diagnosed with malignant tumor in right lung complicated with lymph node metastasis in lung hilum and abdomen,bone metastasis and secondary malignant tumor of adrenal gland.In March 2021,two cycles of immunochemotherapy were dosed in the regimen of pembrolizumab(200 mg),pemetrexed disodium for injection(800 mg) and carboplatin injection(500 mg).Since liver function manifested as Grade 4 immune hepatotoxicity,pembrolizumab was terminated and liver function gradually normalized after dosing of glucocorticoid and hepatoprotective drugs.In May 2022,three cycles of immunochemotherapy were offered in the regimen of pembrolizumab(200 mg) and pemetrexed disodium for injection(800 mg).Liver function manifested as Grade 2 immune hepatotoxicity.After dosing of glucocorticoid and hepatoprotective drugs,liver function gradually normalized.

关 键 词：帕博利珠单抗 免疫性肝毒性 药品不良反应 重启免疫治疗 

分 类 号：R969.3[医药卫生—药理学]