背景:术前免疫化学疗法的扩展导致接受免疫检查点抑制剂(ICIs)的肺癌患者数量增加。因此,肿瘤学家应处理各种免疫相关不良事件(irAE).一种罕见的,危及生命,和最近提出的irAE是细胞因子释放综合征(CRS)。虽然irAE的标准治疗是全身性给予类固醇,有人认为托珠单抗可能是CRS的有效治疗选择.
方法:本病例描述了一名69岁的IIIA期肺腺癌患者,他接受了化疗和纳武单抗,这是一种ICI,作为新辅助免疫化疗。第一次管理后,病人出现了严重的皮疹,发烧,和关节痛.我们怀疑irAE并给予全身性类固醇。然而,发烧和关节痛没有改善,虽然皮疹消失了.这些也是手术的重大挑战。注意到炎症细胞因子水平升高,我们咨询了风湿病学家。最后,我们决定在1个周期后终止新辅助治疗,并给予托珠单抗.Tocilizumab显著改善了患者的症状,并允许他接受根治性手术。病理结果显示,患者获得了主要的病理反应。
结论:这表明托珠单抗早期给药治疗ICI诱导的CRS的潜在有效性,即使在轻微的情况下。
BACKGROUND: The expansion of preoperative immunochemotherapy has led to an increase in the number of patients with lung cancer receiving immune checkpoint inhibitors (ICIs). Therefore, oncologists should manage a variety of immune-related adverse events (irAEs). One of the rare, life-threatening, and recently proposed irAEs is cytokine release syndrome (CRS). Although the standard treatment of irAE is systemic administration of steroids, it has been suggested that tocilizumab may be an effective treatment option for CRS.
METHODS: This case describes a 69-year-old man with stage IIIA lung adenocarcinoma who received chemotherapy and nivolumab, which is an ICI, as neoadjuvant immunochemotherapy. After the first administration, the patient developed severe skin rash, fever, and arthralgia. We suspected irAEs and administered systemic steroids. However, fever and arthralgia did not improve, although the skin rash disappeared. These were also significant challenges for surgery. Noting the elevated levels of inflammatory cytokines, we consulted a rheumatologist. Finally, we decided to terminate neoadjuvant therapy after one cycle and administer tocilizumab. Tocilizumab dramatically improved the patient\'s symptoms and allowed him to undergo radical surgery. Pathological findings revealed that the patient achieved a major pathological response.
CONCLUSIONS: This indicates the potential effectiveness of early tocilizumab administration for ICI-induced CRS, even in mild cases.