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胰腺癌应用Keytruda导致乳糜胸腹水一例并文献复习

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Author:: No author available

Journal Title:: Chinese Journal of Pancreatology

Issue:: 4

DOI:: 10.3760/cma.j.issn.1674-1935.2018.04.011

Key Word:: No keyword available

Abstract：胰腺癌是一种高度恶性的消化系统肿瘤,在全世界范围内每年死亡人数超过200 000例[1].根据美国癌症协会统计,胰腺癌位列癌症相关死亡第4位[2],2015年统计数据显示胰腺癌的5年生存率仅为7.2％[3].由于胰腺癌早期诊断困难,手术切除率低,放化疗联合的多学科治疗是局部晚期及转移性胰腺癌的主要治疗手段.近年来各种实体恶性肿瘤的免疫治疗取得了实质性进展.Pembrolizumab(帕母单抗,商品名Keytruda,美国默沙东公司)是第一个程序性细胞死亡受体1(PD-1)抗体,已经FDA批准用于治疗恶性黑色素瘤、非小细胞肺癌、肾癌、头颈癌和霍奇金淋巴瘤、膀胱癌,以及有高度带微卫星不稳定性(MSI-H)或错配修复缺陷(dMMR)变异的成人和儿童晚期或转移性实体肿瘤.应用Keytruda治疗出现的3或4级不良事件包括转氨酶升高、肾功能衰竭、甲状腺功能减退、疲劳、腹泻、腹痛、食欲减退、皮疹、皮肤瘙痒等,胸腔积液、肺炎和呼吸衰竭的发生率在2％～5％ [4-6].大部分严重不良反应经停药及激素治疗后可好转.长海医院2013至2016年诊治了1例使用Keytruda治疗的胰腺癌患者,出现罕见的乳糜胸腹水,现报道如下.

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