摘要
免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)可恢复机体免疫系统对肿瘤细胞的杀伤能力,在多种实体瘤和血液肿瘤中取得良好疗效,成为近年来肿瘤治疗和研究领域的热点。但其也会产生全新的毒性谱,称为免疫相关不良事件(immune-related adverse events,irAEs)。IrAEs可影响任何组织或器官,若处理不当,可降低抗肿瘤疗效带来的生存获益。尤其累及主要器官(包括心脏、肺和脑)的严重irAEs可能危及生命。IrAEs本质上为炎性/自身免疫性疾病,治疗上通常对激素敏感,对于部分激素抵抗型irAEs,应及早加用免疫抑制剂。深刻认识、基线筛查、早期识别、及时诊断、根据不良反应正确分级和快速足量治疗是管理irAEs的关键。由于irAEs累及器官或系统范围广泛,建立多学科团队优化处理非常必要。对高危人群的预测、irAEs的机制研究及对激素耐药的irAEs免疫抑制剂的正确使用是irAEs领域的热点。本文对目前ICIs相关不良反应的现状及存在问题作一综述,旨在提高临床医生对irAEs的认知,改善临床结果。
Immune checkpoint inhibitors can normalize the previously compromised immune system to kill tumor cells and show remarkable clinical efficacy in a variety of tumors.However,these treatments may lead to unique toxicity profiles that can affect any organ system and can be life-threatening.Immune-related adverse events(irAEs)are essentially inflammatory/autoimmune diseases.Glucocorticoids are usually effective in managing irAEs and for some hormone resistance cases,immunosuppressive agents should be added as early as possible.Due to the wide spectrum of irAEs,its management in a multidisciplinary approach will help to reduce morbidity and is of high necessity.Increased vigilance,baseline screening,timely diagnosis,correct grading,and prompt and sufficient steroid treatment are the keys to the management of irAEs.Prediction of high-risk population,mechanism study of irAEs,and proper use of immunosuppressive agents for hormone-resistant irAEs are hot spots in the field of irAEs.In this commentary,we summarize and discuss the current situation and progress of irAEs,aiming to improve clinicians’awareness of irAEs and clinical outcomes.
作者
陆舜
刘天舒
LU Shun;LIU Tian-shu(The Affiliated Chest Hospital of Shanghai Jiao Tong University, Shanghai Lung Cancer Clinical Medical Centers, Shanghai 200030, China;Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处
《中国临床医学》
2020年第6期903-908,共6页
Chinese Journal of Clinical Medicine
基金
上海市科学技术委员会基金(19DZ1910102)
2020复旦大学附属中山医院智慧医疗专项基金(2020ZHZS02).
关键词
免疫检查点抑制剂
不良反应
肿瘤
激素
immune checkpoint inhibitors
adverse events
tumor
hormone
