阿替利珠单抗致免疫相关性肺炎伴感染1例

A Case of Immune-Associated Pneumonia with Infection Induced by Atezolizumab

摘要: 免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)是一类可以增强人体自身免疫系统的单克隆抗体，广泛应用于在肺癌、黑色素瘤、肾癌等恶性肿瘤的综合治疗。阿替利珠单抗(atezolizumab)是一种针对程序性死亡受体1 (programmed death receptor 1, PD-1)的人类免疫球蛋白G1 (IgG4)单克隆抗体，通过结合肿瘤细胞表面的PD-L1、CD80从而恢复T淋巴细胞活性而阻断免疫逃逸来发挥抗肿瘤作用。阿替利珠单抗是第一个批准用于广泛期小细胞肺癌(extensive period small-cell lung cancer, EP-SCLC)患者的一线治疗方案，但免疫相关不良反应(immune-related adverse events, irAEs)如免疫相关性肺炎(immune-associated pneumonia, IAP)的发生往往不能早诊断，导致临床症状复杂。本文报道一例广泛期小细胞肺癌患者应用阿替利珠单抗后出现严重免疫相关性肺炎并发急性感染。

Abstract: Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that can enhance our immune system, and widely used in the comprehensive treatment of lung cancer, melanoma, kidney cancer and so on. Atezolizumab is a monoclonal antibody against human immunoglobulin G1 (IgG4) that targets programmed death receptor 1 (PD-1). By binding to PD-L1 and CD80 of tumor cells, the activity of T lymphocytes can be restored and immune escape can be blocked to exert anti-tumor effect. Atezolizumab is the first approved ICIs for the first-line therapy in patients with extensive period small-cell lung cancer, but immune related adverse events (irAEs) such as immune associated pneumonia cannot be diagnosed early, resulting in complex clinical symptoms. We report a case of severe immune-associated pneumonia complicated with acute infection in a patient with extensive period SCLC treated with atezolizumab.