Background: This study aimed to systematically review case reports documenting rare adverse events in patients with small cell lung cancer (SCLC) following the administration of immune checkpoint inhibitors (ICIs). Methods: A systematic literature review was conducted to identify case reports detailing previously unreported adverse drug reactions to ICIs in patients with SCLC. The scope of the literature reviewed was restricted to case studies on SCLC published up to 31 December 2023. Results: We analyzed twenty-four studies on ICI use for patients with SCLC. There were six reports on atezolizumab, four on durvalumab, and three on adverse events from monotherapy with nivolumab. Reports involving combination treatments were the most frequent, with a total of six, predominantly involving using nivolumab in combination with ipilimumab. Additionally, there was one report each on using pembrolizumab, nofazinilimab, sintilimab, tislelizumab, and toripalimab. We collected detailed information on the clinical course, including patient and disease characteristics, symptoms, treatment for each adverse event, and recovery status. Among the patients included in the case reports, 21 out of 24 (87.5%) had extensive-stage SCLC when initiating ICI therapy, with only 1 patient diagnosed with limited-stage SCLC. Respiratory system adverse events were most common, with seven cases, followed by neurological, endocrinological, and gastroenterological events. Three case reports documented adverse events across multiple systems in a single patient. In most cases, patients showed symptom improvement; however, four studies reported cases where patients either expired without symptom improvement or experienced sequelae. Conclusions: Efforts to develop reliable biomarkers for predicting irAEs continue, with ongoing research to enhance predictive precision. Immunotherapy presents diverse and unpredictable adverse events, underscoring the need for advanced diagnostic tools and a multidisciplinary approach to improve patient management.
背景：本研究旨在系统综述记录小细胞肺癌（SCLC）患者使用免疫检查点抑制剂（ICIs）后发生罕见不良事件的病例报告。方法：通过系统性文献检索，收集并分析详细描述SCLC患者使用ICIs后出现既往未报道的药物不良反应的病例报告。文献检索范围限定于截至2023年12月31日发表的SCLC相关病例研究。结果：我们分析了24项关于SCLC患者使用ICIs的研究。其中6篇报告涉及阿替利珠单抗，4篇涉及度伐利尤单抗，3篇涉及纳武利尤单抗单药治疗的不良事件。涉及联合治疗的报告最为常见，共6篇，主要为纳武利尤单抗联合伊匹木单抗的治疗方案。此外，各有一篇报告涉及帕博利珠单抗、诺非利单抗、信迪利单抗、替雷利珠单抗和特瑞普利单抗的使用。我们收集了详细的临床病程信息，包括患者与疾病特征、症状表现、各不良事件的治疗措施及恢复状况。在纳入分析的病例报告中，24例患者中有21例（87.5%）在开始ICI治疗时为广泛期SCLC，仅1例患者诊断为局限期SCLC。呼吸系统不良事件最为常见，共7例，其次为神经系统、内分泌系统和消化系统事件。有3篇病例报告记录了同一患者出现多系统不良事件。多数病例中患者症状得到改善；然而，有4项研究报告了患者症状未改善而死亡或出现后遗症的情况。结论：目前持续致力于开发可靠的生物标志物以预测免疫相关不良事件（irAEs），相关研究正不断推进以提高预测准确性。免疫治疗引发的不良事件具有多样性和不可预测性，这凸显了发展先进诊断工具及采用多学科诊疗模式以优化患者管理的必要性。
肿瘤(癌症)患者之家