Safety of checkpoint inhibitors for cancer treatment: strategies for patient monitoring and management of immune-mediated adverse events.
Safety of checkpoint inhibitors for cancer treatment: strategies for patient monitoring and management of immune-mediated adverse events.
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DOI：
10.2147/itt.s141577
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发表时间：
2017
影响因子：
7.2
通讯作者：
Duffield EA
中科院分区：
文献类型：
--
作者：
Davies M;Duffield EA
免疫检查点抑制剂（ICPIs）以抗CTLA-4、PD-1和PD-L1的单克隆抗体的形式出现，极大地改变了几种晚期癌症的治疗方法。由于其作用机制，这些新型药物与独特的免疫介导的不良事件（imAE）谱相关，其安全性特征表明它们比传统化疗药物耐受性更好。本文旨在提供有关ICPI治疗相关imAE的当前知识，包括及时识别、评估和优化管理这些事件的策略和工具。根据已发表的文献、标签指南和作者的患者个人经验，对imAE的识别和管理进行了审查。ICPIs的imAE安全性特征各不相同，取决于特定抗体和所治疗的癌症类型。尽管大多数imAE为轻度且易于管理，但早期识别和积极治疗是降低发生重度imAE的风险并最大限度地提高患者从持续ICPI治疗中获益的可能性的必要措施。作为接受肿瘤治疗患者的主要联系人，护士在识别imAE、教育患者及时报告潜在相关症状的重要性以及协助治疗和随访接受ICPI治疗期间发生imAE的患者方面发挥着关键作用。
Immune checkpoint inhibitors (ICPIs), in the form of monoclonal antibodies against CTLA-4, PD-1, and PD-L1, have dramatically changed the treatment approach in several advanced cancers. Due to their mechanism of action, these novel agents are associated with a unique spectrum of immune-mediated adverse events (imAEs), with a safety profile that indicates they are better tolerated than traditional chemotherapeutic agents. This article aims to provide education on the current knowledge about imAEs associated with ICPI treatment, including strategies and tools for the prompt identification, evaluation, and optimal management of these events. The identification and management of imAEs are reviewed based on published literature, labeling guidelines, and the authors’ personal experience with patients. The imAE safety profiles of ICPIs vary, depending on the specific antibody and the type of cancer being treated. Although most imAEs are mild and easily managed, early identification and proactive treatment are essential actions serving both to reduce the risk of developing severe imAEs and to maximize the potential for patients to receive the benefits of ongoing ICPI treatment. As a primary point of contact for patients undergoing oncology treatment, nurses play a critical role in identifying imAEs, educating patients about the importance of timely reporting of potentially relevant symptoms, and assisting in the treatment and follow-up of patients who develop imAEs while on ICPI therapy.