• PDF / 171,195 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 24 Downloads / 191 Views

DOWNLOAD

REPORT

---

1 S

Sintilimab/granulocyte-macrophage-colony-stimulating-factor Pneumonia

A 57-year-old man developed pneumonia during treatment with sintilimab and granulocyte-macrophage-colony-stimulatingfactor (GM-CSF) for advanced unresectable esophageal squamous cell carcinoma (ESCC). The man, in 2018, was diagnosed with advanced unresectable ESCC with multiple lung and lymph nodes metastases. Subsequently, he received intensity modulated radiotherapy (IMRT) along with chemotherapy including nedaplatin and paclitaxel from 28 February 2020 to 11 April 2020. Unfortunately, his lung lesions progressed two months after the end of chemotherapy, which indicated primary resistance to first-line chemoradiotherapy. As a result, he was treated with rivoceranib [apatinib] and subsequently with catequentinib [anlotinib] but, his lung metastases continued to progress. Consequently, the treatment plan was changed to triple-combination therapy from March 2019. He received sintilimab 200mg, on the day 1 and then was treated with stereotactic body radiotherapy (SBRT) 3 doses/day for metastatic lesion in the right lung. On day 2 after radiotherapy, he received subcutaneous GM-CSF 200 µg/day injected for 2 weeks and the course was repeated every 3 weeks [not all routes stated]. In total 3 courses of triple-combination therapy were administrated, which resulted in significant reduction of tumor burden. However, only the mediastinal lymph nodes had enlarged. Given the benefit, he continued to receive two cycles of sintilimab after completion of triple combination therapy as maintenance treatment. Later, the enlarged lymph nodes decreased, indicating that the initial enlargement in the lesion was pseudo progression. In July 2019, he was diagnosed with new brain metastases with progressive disease. He developed fatigue, hypothyroidism, abnormal liver function and poor appetite. However, after five cycles of sintilimab, he developed symptoms of cough, dyspnea and fever which gradually aggravated. Chest CT scan was performed and, he was diagnosed with severe grade 3–4 pneumonia [duration of treatments to reaction onset not stated]. Sputum culture revealed Acinetobacter epidermidis infection. The development of pneumonia was attributed to triple-combination therapy. The man was treated with IV methylprednisolone and unspecified antibiotics resulting in significant improvement in symptoms. Later, he was discharged from the hospital. However, he had a flare of pneumonia symptoms as he directly discontinued steroid therapy instead of slow tapering. Eventually, in August 2019, the family members refused ventilator-assisted ventilation and, he died of respiratory failure. Zhao X, et al. Anti-PD-1 Immunotherapy Combined With Stereotactic Body Radiation Therapy and GM-CSF as Salvage Therapy in a PD-L1-Negative Patient With Refractory Metastatic Esophageal Squamous Cell Carcinoma: A Case Report and Literature Review. Frontiers in Oncology 10: 2020. Available from: URL: http:// doi.org/10.3389/fonc.2020.01625

0114-9954/20/1831-0001/$14.95 Adis © 2020 Spring