medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-258-264medsovet-5743Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONКлинический случай иммуноопосредованного пневмонита после комбинированного лечения немелкоклеточного рака легкогоA case report of immune-related pneumonitis after combined treatment of non small cell lung cancerhttps://orcid.org/0000-0002-3710-137XДенисоваЕ. С.DenisovaE. S.

Денисова Елена Сергеевна, ординатор отделения лекарственных методов лечения (химиотерапевтическое №17); ординатор кафедры онкологии лечебного факультета

115478, Москва, Каширское шоссе, д. 24

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Elena S. Denisova, Resident of the Department of Medicinal Treatment Methods (Chemotherapeutic No. 17); resident of the Department of Oncology of the Medical Facultyclkk

24, Kashirskoye Shosse, Moscow, 115478

8, Bldg. 2, Trubetskaya St., Moscow, 119991

denielena95@yandex.ruhttps://orcid.org/0000-0002-8967-7987АрдзинбаМ. С.ArdzinbaM. S.

Ардзинба Мераб Сергеевич,к.м.н., научный сотрудник отделения лекарственных методов лечения (химиотерапевтическое №17)

115478, Москва, Каширское шоссе, д. 24 

Merab S. Ardzinba, Cand. of Sci. (Med), Oncologist, Oncological Department of Medicinal Methods of Treatment (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478 

merabii@mail.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович, д.м.н., профессор кафедры онкологии и лучевой терапии лечебного факультета; заведующий онкологическим отделением лекарственных методов лечения (химиотерапевтическое №17)

115478, Москва, Каширское шоссе, д. 24 

117997, Москва, ул. Островитянова, д. 1

Konstantin K. Laktionov, Dr. of Sci. (Med), Professor of the Department of Oncology and Radiation Therapy of the Faculty of Medicine; Head of the Oncological Department of Medical Treatment Methods (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478

 

lkoskos@mail.ruhttps://orcid.org/0000-0002-0620-2696ЮдинД. И.YudinD. I.

Юдин Денис Иванович, к.м.н., старший научный сотрудник

115478, Москва, Каширское шоссе, д. 24 

Denis I. Yudin, Cand. of Sci. (Med.), senior researcher

24, Kashirskoye Shosse, Moscow, 115478 

yudinden@mail.ruhttps://orcid.org/0000-0002-7817-8429СаранцеваК. А.SarantsevaK. A.

Саранцева Ксения Андреевна, к.м.н., врач-онколог

115478, Москва, Каширское шоссе, д. 24 

Ksenia A. Sarantseva, Cand. of Sci. (Med), Oncologist

24, Kashirskoye Shosse, Moscow, 115478 

sarantsevaka@gmail.comhttps://orcid.org/0000-0003-2541-8692ЩербаковаГ. В.ShcherbakovaG. V.

Щербакова Галина Владимировна, к.м.н., доцент, врач-фтизиатр, пульмонолог, кафедра фтизиопульмонологии и торакальной хирургии имени М.И. Перельмана

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Galina V. Shcherbakova, Cand. of Sci. (Med.), Associate Professor, Phthisiatrist, Pulmonologist, Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman

8, Bldg. 2, Trubetskaya St., Moscow, 119991

gallan-1201@mail.ruhttps://orcid.org/0000-0002-9103-1130МариниченкоН. В.MarinichenkoN. V.

Мариниченко Наталия Валентиновна, аспирант отделения лекарственных методов лечения (химиотерапевтическое №17); ординатор кафедры онкологии лечебного факультета

115478, Москва, Каширское шоссе, д. 24 

Nataliya V. Marinichenko, Postgraduate student of the Department of Medicinal Treatment Methods (Chemotherapeutic No. 17); Resident of the Department of Oncology of the Medical Faculty

24, Kashirskoye Shosse, Moscow, 115478 

n.marinichenko@mail.ruНациональный медицинский онкологический центр им. Н.Н. Блохина; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияN.N. Blokhin National Medical Research Center of Oncology; First Moscow State Medical University named after I.M. Sechenov (Sechenov University)Russian FederationНациональный медицинский онкологический центр им. Н.Н. БлохинаРоссияN.N. Blokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский онкологический центр им. Н.Н. Блохина; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияN.N. Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical UniversityRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияFirst Moscow State Medical University named after I.M. Sechenov (Sechenov University)Russian Federation20203007202009258264Copyright © Денисова Е.С., Ардзинба М.С., Лактионов К.К., Юдин Д.И., Саранцева К.А., Щербакова Г.В., Мариниченко Н.В., 20202020Денисова Е.С., Ардзинба М.С., Лактионов К.К., Юдин Д.И., Саранцева К.А., Щербакова Г.В., Мариниченко Н.В.Denisova E.S., Ardzinba M.S., Laktionov K.K., Yudin D.I., Sarantseva K.A., Shcherbakova G.V., Marinichenko N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5743

Иммунотерапия представляет собой наиболее перспективный метод в лечении рака легкого, особенно в связи с быстрорастущей разработкой моноклональных антител, нацеленных на ингибирование контрольных точек иммунитета: антиCTLA-4, антиPD-1, антиPD-L1. Классические иммуноопосредованные нежелательные явления, которые встречаются при этом методе лечения, могут поражать несколько органов, включая легкие. Пневмонит является потенциально опасным для жизни осложнением и зачастую требует быстрого лечения высокими дозами кортикостероидов и антибактериальными препаратами. Мы приводим случай 67-летнего пациента с первично-множественными злокачественными опухолями гортани и левого легкого после комбинированного лечения и неполного курса лечения Ниволумабом, осложненного иммуноопосредованным пневмонитом. В этом отчете подчеркивается важность лечения пациентов с противопоказаниями к проведению химиотерапии при необходимости проведения специфического противоопухолевого лечения, а также своевременного выявления редкого, но опасного нежелательного явления: иммуноопосредованного пневмонита, возникающего на фоне лечения ингибиторами контрольных точек иммунитета. Таким образом, зная частоту развития нежелательных явлений при использовании ингибиторов PD-1 и PD-L1, а также возможное наличие у больных сопутствующей патологии, врачам будет легче принимать обоснованные решения в лечении пациентов, а понимание взаимодействия опухоли и иммунной системы поможет определить лучшие предикторы ответа и дальнейшее улучшение результатов лечения больных с НМРЛ.

Immunotherapy is the most promising method in the treatment of lung cancer, especially in connection with the rapidly growing development of monoclonal antibodies aimed at inhibiting immune checkpoints: anti-CTLA-4, anti-PD-1, anti-PD-L1. Classic immuno-mediated adverse events that occur with this method of treatment can affect several organs, including the lungs. Pneumonitis is a potentially life-threatening complication and often requires rapid treatment with high doses of corticosteroids and antibacterial drugs. We present the case of a 67-year-old patient with primary multiple malignant tumors of the larynx and left lung after combined treatment and incomplete treatment with Nivolumab, complicated by immuno-mediated pneumonitis. This report highlights the importance of treating patients with contraindications to chemotherapy when specific antitumor treatment is required, as well as timely detection of a rare but dangerous adverse event: immuno-mediated pneumonitis that occurs during treatment with immune checkpoint inhibitors. Thus, knowing the frequency of adverse events when using PD-1 and PD-L1 inhibitors, as well as the possible presence of comorbidities in patients, will make it easier for doctors to make informed decisions in the treatment of patients, and understanding the interaction of the tumor and the immune system will help determine the best predictors of response and further improve the results of treatment of patients with NSCLC.

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The authors declare that there are no conflicts of interest present.