程序性细胞死亡蛋白-1及其配体抑制剂对慢性阻塞性肺病合并局部晚期非小细胞肺癌患者的临床应用初探

Preliminary study on the clinical application of programmed cell death protein 1 and its ligand inhibitors in chronic obstructive pulmonary disease with locally advanced non-small cell lung cancer

目的对比并初步探讨程序性细胞死亡蛋白-1(programmed cell death protein-1,PD-1)及其配体(PD-L1)抑制剂对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床疗效、不良反应及预后评估。方法回顾性分析20例本院呼吸科收治的COPD合并局部晚期NSCLC患者,单药使用PD-1及PD-L1抑制剂进行免疫治疗各10例,分别于治疗前以及治疗后4周、8周搜集两组患者相关临床资料并予以对比分析。结果两组都有一定抑制NSCLC生长的作用,用力肺活量(forced vital capacity,FVC)、一秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1占预计值百分率、一氧化碳弥散率、6 min步行距离在内的各临床指标均有改善。PD-L1抑制剂组可能稍有优势。结论PD-1/PD-L1抑制剂可用于治疗局部晚期NSCLC,其中PD-L1抑制剂可能在改善肺功能及避免免疫检查点抑制剂相关肺炎方面存在一定优势,但单药免疫治疗预后欠佳。

Objective To compare and preliminary investigate the clinical efficacy,adverse effects and prognosis assessment of programmed cell death protein 1(PD1)and its ligand(PD-L1)inhibitors in patients with both chronic obstructive pulmonary disease(COPD)and locally advanced non-small cell lung cancer(NSCLC).Methods We retrospectively analyzed 20 cases with both COPD and locally advanced non-small cell lung cancer hospitalized in the department of respiratory medicine of Fujian medical university union hospital and treated by mono-drug immunotherapy,10 of which with PD-1 inhibitors and the other 10 with PD-L1 inhibitors.We examined and collected the relevant clinical data of both groups three times including before treatment,4 weeks after treatment and 8 weeks after treatment,then we compared the data with analysis.Results Both PD-1 and PD-L1 inhibitors provided certain inhibition of lung cancer growth.In all the cases,the examining results of the indicators all improved,including forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1 expressed as a percentage of predicted value,diffusion capacity of the lung for carbon monoxide and 6-minute walk distance,cases treated with PD-1 inhibitors showed a little more improvement.Conclusions PD-1/PD-L1 inhibitors can be used to treat locally advanced non-small cell lung cancer and PD-L1 inhibitors may perform better in improving pulmonary function and reducing the incidence of immune checkpoint inhibitor-associated pneumonitis.