非小细胞肺癌免疫治疗后导致免疫检查点抑制剂相关性肺炎的研究现状

Research Status of Checkpoint Inhibitor Pneumonia following Immunotherapy for Nonsmall Cell Lung Cancer

近年来,随着靶向治疗和免疫检查点抑制剂(ICIs)等新药在非小细胞肺癌治疗领域的广泛应用,非小细胞肺癌患者的生存期和生活质量均有了显著提升。其中,PD-1/PD-L1抑制剂是临床最常用的ICIs。然而,免疫相关的毒性一直是限制ICIs临床应用的重要因素。免疫检查点抑制剂肺炎(CIP)是PD-1/PD-L1治疗中一种重要的毒性。基于循证医学数据,CIP的相关危险因素包括高龄、性别、吸烟状态、鳞状细胞组织学类型、既往肺部疾病、既往胸部放疗以及联合使用其他有肺部毒性的药物。PD-1/PD-L1抑制剂诱导非小细胞肺癌患者CIP的机制较为复杂,研究结果显示,可能的机制主要有T细胞亚群紊乱、部分细胞因子失衡以及其他潜在机制等。

In recent years,with the wide applications of new drugs such as targeted therapy and immune checkpoint inhibitors(ICIs)in the treatment of non-small cell lung cancer,the survival time and quality of life of patients with non-small cell lung cancer have been significantly improved.Among these drugs,PD-1/PD-L1 inhibitor is the most commonly used ICIs in clinic.However,immune related toxicity has always been an important factor limiting the clinical application of ICIs.Checkpoint inhibitor-associated pneumonitis(CIP)is an important toxicity in the PD-1/PD-L1 therapy.Based on evidence-based medicine data,the risk factors related to CIP include old age,gender,smoking status,histological type of squamous cells,previous lung diseases,previous chest radiotherapy and combined uses with other drugs with pulmonary toxicity.The mechanism of inducing CIP in patients with non-small cell lung cancer by PD-1/PD-L1 inhibitors is complex.The research results suggest that the possible mechanisms mainly include T cell subpopulation disorder,imbalance of partial cytokines and other potential mechanisms.