背景:免疫检查点抑制剂(ICIs)是一类新的抗肿瘤药物,已被批准用于治疗多种恶性肿瘤。然而,免疫相关不良事件(irAEs)的发生成为终止治疗的重要原因。ICIs有时会导致腹泻和结肠炎,严重小肠结肠炎可能导致下胃肠道出血和结肠穿孔。ICI相关的结肠炎主要用葡萄糖类固醇和/或靶向肿瘤坏死因子-α的药物治疗。这里,我们描述了一例因抗程序性细胞死亡配体1(PD-L1)(durvalumab)治疗小细胞肺癌肝转移导致的严重ICI相关性结肠炎.患者对可挽救的治疗反应不佳,并最终接受了腹腔镜结肠次全切除术和回肠造口术。此处提供的数据将有助于优化严重ICI相关性结肠炎患者的当前治疗策略。
方法:一名71岁男子入院接受抗PD-L1+IP(durvalumab+伊立替康+顺铂)第二疗程治疗肺癌肝转移,诊断前1个月。第二次给药后四天,患者出现腹痛和血性腹泻。由于患者的抗PD-L1用药史和结肠镜检查结果,他被诊断患有与ICI治疗相关的结肠炎.用足够的糖皮质激素和两个疗程的英夫利昔单抗治疗后,患者出现严重的下消化道出血.经过充分的评估,患者接受了腹腔镜手术治疗,情况稳定出院。
结论:IRAE的早期筛查和分级管理需要多学科团队的共同参与。对于ICI相关结肠炎,药物治疗无效,及时的手术干预可以防止患者死亡。
BACKGROUND: Immune checkpoint inhibitors (ICIs) are a new class of antitumor drugs that have been approved to treat a variety of malignant tumors. However, the occurrence of immune related adverse events (irAEs) has become an important reason for terminating treatment. ICIs sometimes lead to diarrhea and colitis, with severe enterocolitis potentially causing the hemorrhage of the lower gastrointestinal tract and colonic perforation. ICI-associated colitis is primarily treated with glucorticosteroids and/or agents targeting tumor necrosis factor-α. Here, we describe a
case of severe ICI-associated colitis due to anti-programmed cell death ligand 1 (PD-L1) (durvalumab) treatment for small cell lung cancer with liver metastasis. The patient exhibited a poor response to rescuable therapy, and eventually received a laparoscopic subtotal colectomy and ileostomy. The data presented here will contribute to optimizing current treatment strategies for patients with severe ICI-associated colitis.
METHODS: A 71-year-old man was admitted for a second course of anti-PD-L1 + IP (durvalumab + irinotecan + cisplatin) treatment to manage lung cancer with liver metastasis, diagnosed 1 mo previously. Four days after the second dose, the patient developed abdominal pain and bloody diarrhea. Due to the anti-PD-L1 medication history and colonoscopy findings of the patient, he was diagnosed with a colitis associated with ICI treatment. After treatment with sufficient glucocorticoids and two courses of infliximab, the patient developed severe lower gastrointestinal bleeding. After adequate assessment, the patient was treated by laparoscopic surgery, and was discharged in stable condition.
CONCLUSIONS: The early screening and hierarchical management of irAEs need the joint participation of a multidisciplinary team. For ICI-related colitis with ineffective medical treatment, timely surgical intervention could prevent the death of patients.