杜尔瓦卢马布治疗后的渐进性纤维性肺炎:一个具有挑战性的案例
Susana Viana1, Isabel Monteiro1, Marta Vilaça2
1Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT.
Cureus
|February 9, 2026
概括
免疫相关性肺炎 (IrP) 是治疗非小细胞肺癌 (NSCLC) 的杜尔瓦卢马布治疗的一个罕见但严重的副作用. 这一案例突出显示了在发展成纤维化的类固醇耐火性IRP管理方面的挑战.
科学领域:
- 在瘤学瘤学.
- 肺部病理学 肺部病理学
- 免疫学 免疫学 免疫学
背景情况:
- 化学放射治疗 (CRT) 后的杜尔瓦卢马布是不可切除的第三阶段非小细胞肺癌 (NSCLC) 的标准.
- 免疫相关性肺炎 (IrP) 是一种与免疫相关的显著不良事件 (irAE),可以限制治疗疗效.
- 虽然通常对类固醇有反应,但IrP很少发展为慢性纤维化肺病.
研究的目的:
- 报告一个具有挑战性的免疫相关肺炎 (IRP) 病例,在治疗非小细胞肺癌 (NSCLC) 的杜尔瓦卢马布治疗后患有主导性纤维化.
- 为了说明在治疗有纤维化进展的类固醇耐药性IRP的诊断和治疗方面的困难.
- 强调抗纤维素治疗在这种复杂病例中的潜在作用.
主要方法:
- 一名71岁的男性患有IIIc阶段状NSCLC的病例报告,接受了CRT治疗,随后进行了杜尔瓦卢马布治疗.
- 监测与免疫相关的不良事件 (irAEs),特别是与免疫相关的肺炎 (IrP),使用临床评估和计算机断层扫描 (CT) 扫描.
- 治疗包括停用杜尔瓦卢马布,高剂量皮质类固醇,静脉注射甲基普雷迪尼索隆脉冲,以及作为抗纤维菌治疗的宁泰丹尼布.
主要成果:
- 患者在第二次杜尔瓦卢马布循环后出现了恶化的呼吸障碍和双边地面玻璃不透明度,与IRP一致.
- 尽管最初接受了类固醇治疗,但该患者经历了缺血性呼吸衰竭和随着纤维化的进化而逐渐发生的间歇性变化.
- 使用宁泰达尼布的抗纤维素治疗稳定了放射性发现,但临床改善是有限的,最终发生了瘤进展.
结论:
- 经过CRT和杜尔瓦卢马布治疗后,管理具有主导性纤维化的类固醇耐火性IRP会带来重大诊断和治疗挑战.
- 早期识别,密切监测和多学科管理对于患有IRP的患者至关重要.
- 尽管接受免疫抑制治疗,但可以考虑使用抗纤维素疗法,例如宁泰达尼布,以治疗纤维素的演变,尽管结果可能有限.
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