Axitinib plus immune checkpoint inhibitor: evidence- and expert-based consensus recommendation for treatment optimisation and management of related adverse events
Axitinib plus immune checkpoint inhibitor: evidence- and expert-based consensus recommendation for treatment optimisation and management of related adverse events
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DOI：
10.1038/s41416-020-0949-9
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发表时间：
2020-06-26
影响因子：
8.8
通讯作者：
Jonasch, Eric
中科院分区：
文献类型：
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作者：
Grunwald, Viktor;Voss, Martin H.;Jonasch, Eric
随着最近阿西替尼与免疫检查点抑制剂（ICI）派姆单抗或阿维单抗联合用于晚期肾癌的一线治疗获得批准，如何区分ICI引起的免疫相关不良事件（ae）与阿西替尼相关ae的指导对于优化阿西替尼-ICI联合治疗是必要的。本文的建议基于(1)对已发表证据的系统回顾，(2)该领域专家的讨论，以及(3)针对阿西替尼/avelumab和阿西替尼/pembrolizumab联合治疗管理的具体措施进行的调查，以获得专家共识。专家们确定了在使用阿西替尼- ici联合治疗期间需要独特管理的ae领域，这些领域未被当前的建议所涵盖。发现腹泻、肝毒性、疲劳和心血管不良反应适用于这种专门的管理。在免疫抑制和支持措施之间进行分类是治疗管理的关键组成部分。临床监测和两类药物的经验是管理这种新的治疗方法所必需的。我们专注于阿西替尼和ICI治疗之间重叠的ae。我们建议针对阿西替尼- ici联合治疗的AE管理，以提高这些治疗的安全性。
With the recent approval of the combinations of axitinib with the immune checkpoint inhibitor (ICI) pembrolizumab or avelumab for first-line treatment of advanced renal cell carcinoma, guidance on how to distinguish between immune-related adverse events (AEs) caused by ICI versus axitinib-related AEs is necessary to optimise therapy with axitinib-ICI combinations. The recommendations here are based on (1) systematic review of published evidence, (2) discussion among experts in the field and (3) a survey to obtain expert consensus on specific measures for therapy management with the combinations axitinib/avelumab and axitinib/pembrolizumab. The experts identified areas of AEs requiring unique management during treatment with axitinib-ICI combinations that were not covered by current recommendations. Diarrhoea, hepatic toxicity, fatigue and cardiovascular AEs were found to be applicable to such specialised management. Triage between immune-suppressive and supportive measures is a key component in therapy management. Clinical monitoring and experience with both classes of agents are necessary to manage this novel therapeutic approach. We focused on AEs with an overlap between axitinib and ICI therapy. Our recommendations address AE management of axitinib-ICI combinations with the aim to improve the safety of these therapies.