Department of Medical Oncology, Institut Gustave-Roussy, Villejuif.
Department of Radiology, Hôpital Européen Georges Pompidou, Paris.
Ann Oncol. 2012 Aug;23(8):1943-1953. doi: 10.1093/annonc/mds115. Epub 2012 Jun 11.
The administration of mammalian target of rapamycin (mTOR) inhibitors can give rise to a potentially life-threatening adverse event, often referred to as 'non-infectious pneumonitis' (NIP), which is characterized by non-infectious, non-malignant, and non-specific inflammatory infiltrates. Patients usually present with cough and/or dyspnoea. We provide a brief description of the mechanism of action of mTOR inhibitors and their overall safety in patients with metastatic renal cell carcinoma (mRCC) and review the literature on mTOR inhibitor-associated NIP in patients with solid tumours. The review was used to derive questions on the diagnosis, management, and monitoring of mRCC patients with NIP, and to develop a decision tree for use in routine clinical practise. A key recommendation was the subdivision of grade 2 NIP into grades 2a and 2b, where grade 2a is closer to grade 1 and grade 2b to grade 3. This subdivision is important because it takes into account the nature and severity of clinical symptoms potentially related to NIP, either the onset of new symptoms or the worsening of existing symptoms, and thus determines the type and frequency of follow-up. It also helps to identify a subgroup of patients in whom treatment, if effective, may be continued without dose adjustment.
哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂的给药可能会引起潜在危及生命的不良事件，通常称为“非感染性肺炎”（NIP），其特征是非感染性、非恶性和非特异性炎症浸润。患者通常表现为咳嗽和/或呼吸困难。我们简要描述了 mTOR 抑制剂的作用机制及其在转移性肾细胞癌（mRCC）患者中的总体安全性，并回顾了实体瘤患者中 mTOR 抑制剂相关 NIP 的文献。该综述用于得出关于诊断、管理和监测 NIP 的 mRCC 患者的问题，并为常规临床实践开发决策树。一项关键建议是将 2 级 NIP 细分为 2a 级和 2b 级，其中 2a 级更接近 1 级，2b 级更接近 3 级。这种细分很重要，因为它考虑到了与 NIP 相关的临床症状的性质和严重程度，无论是新症状的出现还是现有症状的恶化，从而确定了随访的类型和频率。它还有助于确定一个亚组患者，如果治疗有效，可能无需调整剂量即可继续治疗。
