目的 分析帕博利珠单抗致免疫相关性肺炎发生情况、临床特点、治疗与转归情况,为临床治疗过程中免疫相关性肺炎的鉴别及处置提供参考。方法 检索PubMed、中国知网、维普数据库和万方数据库关于帕博利珠单抗致免疫相关性肺炎的文献并进行分析。结果 帕博利珠单抗致免疫相关性肺炎的个案报道共58例,男性42例,女性15例；年龄40~91岁,中位年龄65岁；原发病非小细胞肺癌26例,黑色素瘤21例,结肠癌3例,肺多形性癌2例,小细胞肺癌、食管癌、肺大细胞神经内分泌癌、鼻咽癌、乳腺癌、胶质瘤各1例；单用帕博利珠单抗者56例,联用卡铂、培美曲塞者1例,联用卡铂、紫杉醇(白蛋白结合型)并联合放射治疗者1例。CIP发生时间最短为1天,最长为2年零2个月,中位时间12周。CIP主要临床症状呼吸困难、发热、咳嗽；影像学主要表现有GGOs、实变、结节、间质性改变。54例经停药和对症治疗后好转,8例死于CIP。好转后,4例患者再次给予帕博利珠单抗治疗,耐受良好。结论 帕博利珠单抗治疗过程中需关注患者的临床症状及肺部影像学特征,尽早识别免疫相关性肺炎,发生免疫相关性肺炎的患者需根据其严重程度不同予以相应的治疗手段,尤其重症患者警惕其致命风险。

Objective To analyze the incidence, clinical characteristics , treatment and outcome of immune-related pneumonitis caused by Pembrolizumab, so as to provide reference for the differentiation and treatment of immune-related pneumonitis during clinical treatment. Methods PubMed, CNKI, VIP, and Wanfang Database were searched for immune-related pneumonitis induced by Pembrolizumab, and selected literatures were further analyzed statistically. Results A total of 58 cases of immune-related pneumonitis induced by Pembrolizumab were identified and included. Including 42males and 15 females, aged from 40 to 91 years with a median age of 65 years. The primary diseases in 26 cases were NSCLC, in 21 cases were melanoma, in 3 cases were colon cancer, in 2 pulmonary pleomorphic carcinoma, and in 6 patients were SCLC, esophageal cancer, pulmonary large?cell neuroendocrine carcinoma, nasopharyngeal cancer ,breast cancer and glioblastoma, respectively. Fifty-six patients received pembrolizumab as monotherapy, 1 patient received combination therapy of pembrolizumab with carboplatin and pemetrexed, and 1 patients received pembrolizumab combined with carboplatin, paclitaxel protein-bound and radiation therapy. Time to onset of CIP was 1 day at the shortest and 2 years and 2 months at the longest with a median time of 12 weeks. The symptoms of CIP mainly were dyspnea, fever and cough. The common radiological features were ground glass opacities, consolidations, nodules and interstitial pneumonitis. Fifty-four patients were improved after durg withdrawal and symptomatic treatment, 8 patients died. Four patients underwent rechallenge with pembrolizumab and well tolerated. Conclusions The clinical symptoms and lung imaging characteristics of patients with immune-related pneumonitis should be paid attention during the treatment with pembrolizumab. Patients with immune-related pneumonitis should be treated according to their severity, especially those with severe disease.