Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
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DOI：
10.1093/annonc/mdx225
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发表时间：
2017-07-01
影响因子：
50.5
通讯作者：
Jordan, K.
中科院分区：
文献类型：
--
作者：
Haanen, J. B. A. G.;Carbonnel, F.;Jordan, K.
针对细胞毒性T淋巴细胞相关抗原4 （CTLA4）和程序性死亡-1受体（PD-1）及其配体PD-L1的单克隆抗体（MoAbs）免疫治疗已成为越来越多适应症的标准治疗方法（表1）。因此，越来越多的患者将暴露于这些药物，并有可能因这些治疗而产生毒性。根据所针对的免疫检查点不同，毒性的发生率也不同。免疫检查点抑制剂（ICPis）的毒性可分为输注反应和免疫相关不良事件（irAEs）或特殊关注不良事件（AEoSI）。后者将是这些临床实践指南的主题。任何器官或组织都可能受累，尽管有些irae比其他irae更常见。最常见的irae会影响皮肤、结肠、内分泌器官、肝脏和肺部。其他的则很少发生，但可能非常严重，甚至致命，如神经系统疾病和心肌炎。
Immunotherapy with monoclonal antibodies (MoAbs) targeting cytotoxic T lymphocyte-associated antigen 4 (CTLA4) and the programmed death-1 receptor (PD-1) and its ligand PD-L1 has become standard of care for an increasing number of indications (Table 1). Therefore, an increasing number of patients will be exposed to these drugs with a chance of developing toxicities from these treatments. Depending on the immune checkpoint that is targeted, the incidence of toxicity varies. Toxicities from immune checkpoint inhibitors (ICPis) can be divided into infusion reactions and immune-related adverse events (irAEs) or adverse events of special interest (AEoSI). The latter will be the subject of these Clinical Practice Guidelines. Any organ or tissue can be involved, although some irAEs occur much more commonly than others. The most frequently occurring irAEs affect skin, colon, endocrine organs, liver and lungs. Others are very infrequent, but may be very serious, even lethal, such as neurological disorders and myocarditis.