Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer.
Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer.
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DOI：
10.1183/16000617.0058-2019
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发表时间：
2019-09-30
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免疫检查点抑制物相关肺炎(ICI-P)在癌症治疗过程中很少观察到(<；5%)。ICI-P在非小细胞肺癌(NSCLC)患者中比在其他癌症患者中更常见。同样，在接受程序性细胞死亡(PD)-1/PD-1配体抑制剂而不是细胞毒性T淋巴细胞抗原(CTLA)-4抑制剂的患者中，这种情况更常见。联合应用抗PD-1抗体和抗CTLA-4抗体时，ICI-P发生率较高。尽管死亡率较低(≈为13%)，ICI-P仍是ICI相关死亡的主要原因。本文综述ICI-P的流行病学、临床和放射学表现及预后，特别是晚期非小细胞肺癌患者的ICI-P。重点放在根据ICI是作为单一疗法还是与另一种ICI或化疗联合使用而观察到的频率或临床图像方面的差异。回顾了在癌症患者中观察到的其他肺部并发症，但不一定与免疫相关，如结节样肉芽肿、结核病或其他感染。基于文献中报道的ICI-P系列和出版的指南，提出了一项务实的管理建议，包括鉴别诊断和治疗策略。免疫检查点抑制物相关肺炎(ICI-P)很少见。尽管死亡率很低，但它是与ICIS有关的主要死亡原因。通过停止免疫治疗和迅速使用皮质类固醇来识别和处理ICI-P至关重要。Http://bit.ly/2Ldsp3n
Immune checkpoint inhibitor-related pneumonitis (ICI-P) during cancer treatment is rarely observed (<5%). ICI-P is more often observed in patients with nonsmall cell lung cancer (NSCLC) than in those with other cancers. Likewise, it is more common in those receiving programmed cell death (PD)-1/PD-1 ligand inhibitors rather than cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors alone. The frequency of ICI-P is higher when anti-PD-1 and anti-CTLA-4 are administered concomitantly. Despite the low fatality rate (≈13%), ICI-P is the leading cause of ICI-related deaths. This narrative review focuses on the epidemiology, clinical and radiological presentation and prognosis of ICI-P occurring in patients, especially those with advanced NSCLC. Emphasis is placed on the differences in terms of frequency or clinical picture observed depending on whether the ICI is used as monotherapy or in combination with another ICI or chemotherapy. Other pulmonary complications observed in cancer patients, yet not necessarily immune-related, are reviewed, such as sarcoid-like granulomatosis, tuberculosis or other infections. A proposal for pragmatic management, including differential diagnosis and therapeutic strategies, is presented, based on the ICI-P series reported in the literature and published guidelines. Immune checkpoint inhibitor-related pneumonitis (ICI-P) is rare. Despite a low fatality rate, it is the leading cause of death in relation to ICIs. It is crucial to recognise and manage ICI-P by stopping immunotherapy and quickly starting corticosteroids. http://bit.ly/2Ldsp3n
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