PDF(Pubmed)
Abstract：
Atezolizumab is a programmed death-ligand 1 (PD-L1) targeted antibody that prevents the binding of PD-L1 to specific T-cell receptors, thereby increasing anticancer immunity. It has been regarded as a useful first-line treatment in patients with small-cell lung cancer with a more tolerable side effect profile than chemotherapeutic agents. However, few studies focusing on the severity of adverse effects from immune checkpoint inhibitors (ICPI) have been previously reported, particularly acute fulminant colitis requiring surgical invention. We report a case of fulminant colitis refractory to high dose corticosteroid treatment in a patient with known ulcerative colitis (UC) undergoing treatment for small-cell lung cancer (SCLC) with atezolizumab. The upregulation of PD-L1 expression in patients with ulcerative colitis may play a significant role in an imbalanced T-helper cell response creating a pro-inflammatory state. The use of ICPIs to treat SCLC has been reported to increase the risk of developing inflammatory colitis. Atezolizumab use in a patient with known inflammatory bowel disease (IBD) may predispose this population to a higher risk of developing severe inflammatory colitis. We present an unusual complication associated with medical intervention in an immunocompromised patient without an established pathophysiology. The suspicion of using ICPIs in patients with IBD as a potential cause for the development of fulminant colitis is relevant and essential in the diagnostic workup for this patient population complaining of significant gastrointestinal symptoms.
摘要：
Atezolizumab是一种程序性死亡配体1（PD-L1）靶向抗体，可防止PD-L1与特定T细胞受体结合，从而增加抗癌免疫力。在小细胞肺癌患者中，它被认为是一种有用的一线治疗方法，其副作用比化学治疗剂更具耐受性。然而,先前很少有关于免疫检查点抑制剂（ICPI）不良反应严重程度的研究报道，特别是需要手术发明的急性暴发性结肠炎。我们报告了一例高剂量皮质类固醇治疗难治性暴发性结肠炎的病例，该患者患有已知的溃疡性结肠炎（UC），正在接受阿特珠单抗治疗小细胞肺癌（SCLC）。溃疡性结肠炎患者PD-L1表达的上调可能在产生促炎状态的不平衡T辅助细胞反应中起重要作用。据报道，使用ICPIs治疗SCLC会增加患炎症性结肠炎的风险。在已知的炎症性肠病（IBD）患者中使用阿替珠单抗可能会使该人群发生严重炎症性结肠炎的风险更高。我们提出了在没有确定的病理生理学的免疫受损患者中与医疗干预相关的异常并发症。怀疑在IBD患者中使用ICPIs是暴发性结肠炎发展的潜在原因，这在该患者人群抱怨有明显胃肠道症状的诊断检查中是相关且必不可少的。
