肺癌发病率和死亡率均位居世界癌症前列，约85%的肺癌为非小细胞肺癌（non-small cell lung cancer，NSCLC），大多数患者在确诊时已是晚期，5年生存率较低，严重危害人类生命和健康。中医药在恶性肿瘤综合治疗中具有重要作用，口服中成药作为中医药的重要组成部分，具有制剂稳定、口感温和、携带方便、有效成分确切等区别于汤剂的优点，已广泛用于NSCLC的辅助治疗，在临床应用中不管是联合化疗、靶向治疗、放射治疗，还是单用维持治疗均可发挥增效减毒的功效，使治疗有效率提高，治疗相关毒副反应减轻，进而延长患者生存时间，改善患者生活质量。口服中成药辅助治疗NSCLC的作用机制主要包括抑制肺癌细胞的增殖、侵袭与转移，促进肺癌细胞凋亡，抑制肿瘤新生血管生成，逆转多药耐药，调节机体免疫功能，体现了中医药通过多途径、多通路、多靶点发挥抗肿瘤作用的特点。目前临床上常用于治疗NSCLC的口服中成药包括金复康口服液、参一胶囊、平消胶囊、消癌平片、康莱特胶囊、复方斑蝥胶囊、回生口服液、养正消积胶囊、西黄丸、紫龙金片、华蟾素胶囊等，这些中成药治疗NSCLC的临床与基础研究均较多，但缺乏系统性整合与梳理，故该文对目前临床上常用的口服中成药辅助治疗NSCLC的作用机制及临床应用研究进展进行系统综述，以期为后续研究和临床治疗提供参考。
近年来,随着免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)在肿瘤治疗中的广泛应用,免疫治疗相关不良反应逐渐引起人们的关注.免疫检查点抑制剂相关肺炎(checkpoint inhibitor pneumonitis,CIP)是相对少见的免疫治疗相关肺毒性,也是引起ICIs相关死亡的重要原因之一.积极探索CIP的相关危险因素,甄别出发生CIP的高危人群,有利于CIP的早期诊断、及时治疗.故本文就CIP的危险因素及管理策略研究进展进行综述,以提高临床医生对该不良反应的认识.
RATIONALE:Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of various types of cancers worldwide, which is the most significant breakthrough in cancer therapy in recent years. Despite their excellent benefits in anti-tumor efficacy, a subset of patients will experience various autoimmune toxicities, termed as immune-related adverse events (irAEs), which can affect almost any organ systems, but related to the pulmonary and pancreatic islets simultaneously has rarely been reported and discussed.PATIENT CONCERNS:In this report, we describe a rare case of a 65-year-old man patient with advanced small cell lung cancer (SCLC) who suffered general fatigue, dry cough, chest tightness, shortness of breath and polyuria-polydipsia syndrome after the eighth cycle treatment with programmed cell death ligand-1 (PD-L1) inhibitor durvalumab.DIAGNOSES:According to the results of laboratory tests, chest computed tomography and multidisciplinary discussion, the patient was eventually diagnosed with ICI-related pneumonitis and autoimmune diabetes mellitus.INTERVENTIONS:Multiple daily subcutaneous insulin injections, empirical anti-infection and immunosuppression treatment with corticosteroids were performed.OUTCOMES:After the cessation of durvalumab and comprehensive treatment, the patient's respiratory condition was relieved significantly and his blood glucose was well controlled with insulin therapy.LESSONS:With the widespread use of ICIs, there will be more patients developing these rare but severe irAEs in clinical practice, which should attract great attention of both clinicians and patients.
