卡瑞利珠单抗治疗晚期非小细胞肺癌致内分泌系统不良反应临床观察

Clinical observation of endocrine system adverse reactions related to camrelizumab treatment for advanced non-small cell lung cancer

目的探讨程序性死亡受体(PD-1)抑制剂卡瑞利珠单抗治疗晚期非小细胞肺癌过程中内分泌系统的免疫相关不良反应(irAEs)的临床情况。方法回顾性分析2019年1月1日至2021年12月31日南京市第二医院收治的共86例接受卡瑞利珠单抗治疗的晚期非小细胞肺癌病人,观察治疗期间发生的内分泌系统不良反应,包括甲状腺功能减退症(甲减)、甲状腺功能亢进症(甲亢)、垂体炎、1型糖尿病、甲状旁腺功能亢进症(甲旁亢)或甲状旁腺功能减退症(甲旁减)等。结果86例病人中,17例(19.8%)发生内分泌系统irAEs,其中甲减11例(1~2级10例,3级1例),甲亢2例(1级),甲状腺炎1例(1级),1型糖尿病1例(3级),垂体炎1例(2级),甲旁亢1例(3级),甲旁减0例,未见4级及以上内分泌系统不良反应。发生内分泌系统不良反应的中位时间为首次卡瑞利珠单抗治疗后13.1周。2级及以下irAEs病人经对应治疗后均可以继续接受卡瑞利珠单抗治疗,3级irAEs病人后续根据具体情况可考虑停用卡瑞利珠单抗。结论在使用卡瑞利珠单抗过程中,发生内分泌系统irAEs风险相对较高,其中尤以甲状腺功能障碍发生率较高;但定期监测、及时治疗是安全可控的。

Objective To explore the clinical situation of immune-related adverse reactions(irAEs)in the endocrine system during the treatment of advanced non-small cell lung cancer with the programmed death receptor(PD-1)inhibitor camrelizumab.Methods A total of 86 patients with advanced non-small cell lung cancer(NSCLC)who received camrelizumab treatment from January 1,2019 to December 31,2021,at Nanjing Second Hospital were retrospectively analyzed.The adverse reactions of the endocrine system,including hypothyroidism(hypothyroidism),hyperthyroidism(hyperthyroidism),pituitary gland inflammation,type 1 diabetes mellitus,hyperparathyroidism(hyperparathyroidism),or hypoparathyroidism(hypoparathyroidism),occurring during the treatment period were observed.Results Among 86 patients,endocrine system irAEs occurred in 17 cases(19.8%),including 11 cases of hypothyroidism(10 cases of grade 1-2 and 1 case of grade 3),2 cases of hyperthyroidism(grade 1),1 case of thyroiditis(grade 1),1 case of type 1 diabetes mellitus(grade 3),1 case of pituitary inflammation(grade 2),1 case of hyperparathyroidism(grade 3),and 0 cases of hypoparathyroidism.No grade 4 or above endocrine system adverse reactions were observed.The median time to occurrence of endocrine system adverse reactions was 13.1 weeks after the first camrelizumab treatment;patients with grade 2 and lower irAEs can continue to receive camrelizumab after corresponding treatment;patients with grade 3 irAEs can be considered for subsequent discontinuation of camrelizumab on a case-by-case basis.Conclusion Endocrine system irAEs are at relatively high risk during the use of camrelizumab,with a particularly high incidence of thyroid dysfunction,but regular monitoring and timely treatment are safe and controllable.