内容紹介
Summary
We present an unusual case of late—onset acute pneumonitis developing 21 months after pembrolizumab monotherapy. An 80—year—old male with primary, pulmonary, squamous cell carcinoma underwent right lower lobectomy and lymph node dissection(ND2a—2);the postoperative pathological stage was ⅢA(pT2bN2M0)and the PD—L1 tumor proportion score 70%. Six months after surgery, he developed mediastinal lymph node(#2R), bilateral pulmonary, and hepatic metastases;pembrolizumab was administered every 3 weeks as a first—line treatment. A partial response was evident after 3 courses;we thus continued the monotherapy. However, after 28 courses(21 months)of pembrolizumab, we discontinued the regimen because acute pneumonitis(Grade 3)developed;we prescribed prednisolone at 50 mg/day. The acute pneumonitis shadow improved and prednisolone was tapered over 2 months. The patient exhibited no new lesion and no progressive disease 6 months after pembrolizumab was discontinued.
要旨
術後再発に対してペムブロリズマブ投与21か月後に遠隔期に急性肺臓炎を発症した比較的まれな1例を経験したので報告する。症例は80歳,男性。原発性肺癌のため右下葉切除(ND2a—2)を施行し,扁平上皮癌,pT2bN2M0,stage ⅢA,完全切除であった。術後6か月後に縦隔リンパ節(#2R),両側多発肺内転移,多発肝転移を認め,PD—L1発現は70%であったためペムブロリズマブ単剤(3週毎投与)を開始した。3コース目投与後効果判定で部分奏効維持となっていたが,28コース目(投与開始21か月後)に急性肺臓炎(Grade 3)を発症したため,ペムブロリズマブを中止しプレドニゾロン50 mg/日を投与開始した。間質性陰影は消失傾向を示したため,プレドニゾロンを約2か月かけて漸減させた。現在,経過観察中でペムブロリズマブ中止後6か月経過しているが,病勢進行を認めていない。
目次
We present an unusual case of late—onset acute pneumonitis developing 21 months after pembrolizumab monotherapy. An 80—year—old male with primary, pulmonary, squamous cell carcinoma underwent right lower lobectomy and lymph node dissection(ND2a—2);the postoperative pathological stage was ⅢA(pT2bN2M0)and the PD—L1 tumor proportion score 70%. Six months after surgery, he developed mediastinal lymph node(#2R), bilateral pulmonary, and hepatic metastases;pembrolizumab was administered every 3 weeks as a first—line treatment. A partial response was evident after 3 courses;we thus continued the monotherapy. However, after 28 courses(21 months)of pembrolizumab, we discontinued the regimen because acute pneumonitis(Grade 3)developed;we prescribed prednisolone at 50 mg/day. The acute pneumonitis shadow improved and prednisolone was tapered over 2 months. The patient exhibited no new lesion and no progressive disease 6 months after pembrolizumab was discontinued.
要旨
術後再発に対してペムブロリズマブ投与21か月後に遠隔期に急性肺臓炎を発症した比較的まれな1例を経験したので報告する。症例は80歳,男性。原発性肺癌のため右下葉切除(ND2a—2)を施行し,扁平上皮癌,pT2bN2M0,stage ⅢA,完全切除であった。術後6か月後に縦隔リンパ節(#2R),両側多発肺内転移,多発肝転移を認め,PD—L1発現は70%であったためペムブロリズマブ単剤(3週毎投与)を開始した。3コース目投与後効果判定で部分奏効維持となっていたが,28コース目(投与開始21か月後)に急性肺臓炎(Grade 3)を発症したため,ペムブロリズマブを中止しプレドニゾロン50 mg/日を投与開始した。間質性陰影は消失傾向を示したため,プレドニゾロンを約2か月かけて漸減させた。現在,経過観察中でペムブロリズマブ中止後6か月経過しているが,病勢進行を認めていない。