PD-1 Inhibitor Was Used To Treat 3 Cases Of Advanced Lung Squamous Cell Carcinoma

Objective: In recent years,advanced lung squamous cell carcinoma is mainly treated by chemotherapy with poor therapeutic effect.The appearance of immunotherapy brings new hope to patients.By reporting 3 cases of advanced lung squamous cell carcinoma treated with PD-1 inhibitor and reviewing the literature,we provided clinicians with a further understanding of immunotherapy for lung cancer.Methods: Clinical data of 3 patients with advanced lung squamous cell carcinoma treated with PD-1 inhibitor were collected."Lung squamous cell carcinoma","lung squamous cell carcinoma" and "immunotherapy" were used as search terms in Chinese,and "lung squamous cell carcinoma","lung squamous cell carcinoma" and "immune therapy" were searched in cnki,wanfang database,zhongqing vipu and Pub Med database.The search time was limited to January 1,2010,solstice,May 1,2020.The literature of clinical trial and retrospective analysis of programmed death-Ligand 1(PD-L1)inhibitor for lung squamous cell carcinoma is collected and reviewed.Results :(1)Case 1 was a 26-year-old male with no history of smoking.The main symptoms were repeated cough and sputum.The serum CA125 was55.8u/m L.Fiber bronchoscope in right in the middle of opening the cauliflowerlike neoplasm jams lumen,pathological support(right in the middle of openings)squamous cell carcinoma,PD-L1 expression score > 25%,stage for T4N2M0 IIIB,palmer show bead used single resistance(200 mg every 3 weeks)joint platinum chemotherapy after 2 cycles the CT shows significant reduction,primary tumor review serum CA125 is 25.9 U/ml,evaluation for complete response(complete response,CR),progression-free surial was 2.1 months.The patient is a carrier of hepatitis B virus,liver function damage appears in the treatment process,liver function is normal before treatment,after liver protection treatment is improved.(2)Case 2 is a 57-year-old male who has been smoking for more than40 years.His main symptoms are cough and sputum.His serum CA125 is 9.7U/ml.Under fiberoptic bronchoscopy,new organisms with vegetable pattern were seen in carina protuberance,about 80% of the right lumen was blocked,and about 90%of the right basal segment was blocked by new organisms.Electrotomy pathology of lung mass under fiberbronchoscope indicated squamous cell carcinoma,p DL1 tumor expression score was 80%,stage T4N3M0 IIIB.On February 11,2020,taxol liposome + carboplatin chemotherapy was given for 1 cycle,and combined with Endu to resist angiogenesis,resulting in chutziness and chutziness during taxol infusion.The tumor progression was reviewed after 37 days,and docetaxel+ carboplatin + tirelizumab were given for 2 cycles on March 6,2020.The reexamination of chest CT showed no significant changes in the lesions,serum CA125 was 15.5U/ml,the disease was assessed as stable,and the progressie-free survival was 1.5 months.During the treatment,liver function was damaged,but the patient had a history of taking Traditional Chinese medicine,and improved after liver protection treatment..(3)Case 3 was a 48-year-old male who had smoked for more than 20 years,and his main symptoms were chest pain.His serum LEVEL of CA125 was 175.3U/ml.Chest CT showed a mass of about5.5×4.2×3.8cm high density shadow in the posterior basal segment outside the lower lobe of the right lung.Biopsy of the right lung revealed squamous cell carcinoma.The stage is T4N3M1 IVB.On November 27,2018,paclitaxel liposome + nedaplatin treatment was performed for 2 cycles,and the newly observed inflammation and pleural effusion in the middle lobe of the right lung were reviewed to evaluate progressive disease(PD).On January 12,2019,docetaxel + nedaplatin were given 2 cycles of treatment,and CT reexamination of pulmonary lesions and bone metastasis compared with previous progress was performed to evaluate PD.Complete tissue examination showed that p D-L1 tumor expression was 90%.After 15 cycles of treatment,the tumor was reexamined on chest CT,and the serum level of CA125 was 15.4 U/ m L,which was evaluated as CR,and the progress-free survival was 12.3months.(4)Literature retrieval results: the retrieval time was limited to January 1,2010 solstice May 1,2020.There were 6 English literatures in clinical trials and clinical retrospective analysis,among which 5 were clinical trials and 1 was retrospective analysis.A total of 2044 cases were included,ranging in age from23 to 86 years old,including 1645 males and 399 females.There were 1884 cases with smoking history,154 cases with never smoking,6 cases with uncertain smoking status,85 cases with stage IIIB,1,952 cases with stage IV,and 7 cases with no stage provided.The ECOG status score was 0 for 523 cases,1 for 1225 cases,2 for 3 cases and 10 unknown.Three immunocheckpoint inhibitors(Nivolumab,pembrolizumab and ATEzolizumab)were involved.On immune checkpoint inhibition as a linear combination of the two studies,the median OS immune joint group were than the pure chemotherapy group(15.9 months and11.3 months,14.2 months and 13.5 months),progression-free survival than chemotherapy group(6.4 months and 4.8 months,respectively,6.3 months and5.6 months),and immune MDT group grade 3-4 with chemotherapy group and the difference(69.8% and 68.2 respectively,1.8% and 0.3%).In second-line and above regimens,the median OS for monotherapy was 8.3-16.3 months,and the median progression-free survival was 1.3-5.3 months.In NIvolumab monotherapy,grade 1-4 adverse reactions were 58-85%,but grade 3-4 adverse reactions were all less than 20%.In the 4 studies of nivolumab monotherapy,adverse reactions occurred including skin,digestive system,respiratory system,blood system,endocrine system,nervous system,fatigue,joint pain,etc.Conclusions:(1)PD-1 inhibitor has a certain therapeutic effect on advanced lung squamous cell carcinoma,and may prolong the progression-free survival of patients.(2)Chemotherapy combined with PD-1 inhibitor did not increase grade3-4 adverse reactions in the treatment of advanced lung squamous cell carcinoma.(3)The adverse reactions caused by PD-1 inhibitors in the treatment of advanced lung squamous cell carcinoma are common and of various types,which should be observed clinically.The number of cases included in this study is small,which needs a lot of research data to support.