信迪利单抗联合重组人血管内皮抑素和GP方案一线治疗Ⅲ期肺鳞癌并慢性阻塞性肺疾病1例并文献复习

罗详冲 毛贵兵 王周清

[摘要]目前晚期肺癌的诊治从化疗迈向基因靶向治疗再到免疫治疗，从单药到联合治疗，治疗模式发生了彻底改变。程序性死亡受体1（PD-1）和程序性死亡配体1（PD-L1）抑制剂在驱动基因阴性的晚期非小细胞肺癌（NSCLC）患者中取得显著的疗效，重塑了晚期 NSCLC 的一线、二线和三线的治疗格局。本文总结一例 PD-1抑制剂信迪利单抗联合重组人血管内皮抑素和吉西他滨（GEM）联合顺铂（DDP）一线治疗Ⅲ期肺鳞癌并慢性阻塞性肺疾病（COPD）患者的疗效及安全性，为临床提供参考。

[关键词]肺鳞癌;慢性阻塞性肺疾病;信迪利单抗;重组人血管内皮抑素;免疫治疗;化学治疗

[中图分类号] R734.2 [文献标识码] A  [文章编号]2095-0616（2021）22-0228-04

A case of first-line treatment of stage Ⅲ lung squamous cell carcinoma complicated with chronic obstructive pulmonary disease with sintilimab combined with recombinant human endostatin and GP regimen and the literature review

LUO  Xiangchong   MAO  Guibing   WANG  Zhouqing

Department of Cardiothoracic Surgery， Qujing Second People's Hospital， Yunnan， Qujing 655000， China

[Abstract] At present， the diagnosis and treatment of advanced lung cancer has developed from chemotherapy to gene targeted therapy and then to immunotherapy， and from single drug to combined therapy， with radical transformation of the treatment pattern. Programmed death receptor-1（PD-1） and programmed death ligand-1（PD-L1） inhibitors have achieved remarkable efficacy in the patients with advanced non-small cell lung cancer （NSCLC） with negative driver genes， reshaping the first-line， second-line and third-line treatment patterns of advanced NSCLC. This paper summed up the efficacy and safety of first-line treatment of a patient with stage Ⅲ lung squamous cell carcinoma complicated with chronic obstructive pulmonary disease with PD-1 inhibitor sintilimab combined with recombinant human endostatin and gemcitabine （GEM） combined with cisplatin （DDP）， providing reference for clinical practice.

[Key words] Lung squamous cell carcinoma; Chronic obstructive pulmonary disease; Sintilimab; Recombinant human endostatin; Immunotherapy; Chemotherapy

肺癌是目前全世界范圍内发病率和死亡率均最高的恶性肿瘤。非小细胞肺癌（non-small cell lung cancer， NSCLC）是最常见的肺癌类型，约占肺癌总数的85%，其中，肺鳞癌（squamous cell lung cancer， SQCLC）占 NSCLC 的30%[1]。然而，由于肺鳞癌的高肿瘤突变负荷（tumor mutation burden， TMB）和高度异质性，使得晚期肺鳞癌的治疗难度大且预后差。既往晚期肺鳞癌的一线治疗以吉西他滨（gemcitabine， GEM）联合铂类或紫杉醇联合铂类化疗为首选治疗方案，但疗效不佳。随着免疫治疗的兴起，以程序性死亡受体1（programmed death 1，PD-1）抑制剂为首的治疗在晚期肺鳞癌领域中取得突破性进展，尤其是 PD-1抑制剂联合化疗或抗血管生成治疗彻底改变了晚期肺鳞癌的一线、二线乃至后线治疗的选择[2-5]。本文报道1例接受信迪利单抗（Sintilimab，达伯舒）联合重组人血管内皮抑素（recombinant human endostatin， Rh- endostatin，恩度）和 GP 方案[（GEM+顺铂（cisplatin， DDP）]一线治疗的Ⅲ期肺鳞癌并慢性阻塞性肺疾病（chronic obstructive pulmonary disease， COPD）患者，且耐受性良好，临床获益明显。……