Dermatology Service, Department of Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, Pennsylvania 15260, USA.
Nat Rev Clin Oncol. 2016 Aug;13(8):473-86. doi: 10.1038/nrclinonc.2016.58. Epub 2016 May 4.
Inhibition of immune checkpoints using anti-programmed cell death-1 (PD-1) or anti cytotoxic-T-lymphocyte-associated antigen 4 (CTLA-4) monoclonal antibodies has revolutionized the management of patients with advanced-stage melanoma and is among the most promising treatment approaches for many other cancers. Use of CTLA-4 and PD-1 inhibitors, either as single agents, or in combination, has been approved by the US FDA for the treatment of metastatic melanoma. Treatment with these novel immunotherapies results in a unique and distinct spectrum of adverse events, which are mostly related to activation of the immune system and are, therefore, an unwanted consequence of their mechanisms of action. Adverse effects of CTLA-4 and/or PD-1 inhibition are most commonly observed in the skin, gastrointestinal tract, liver and endocrine systems and include pruritus, rash, nausea, diarrhoea and thyroid disorders. In this Review, the authors describe the adverse event profile of checkpoint inhibitors targeting CTLA-4 and PD-1, used both as monotherapies and in combination and aim to provide some general guidelines, based upon the mechanisms of action of these therapies and on the management of these immune-related adverse events.
使用抗程序性细胞死亡蛋白 1(PD-1)或抗细胞毒性 T 淋巴细胞相关抗原 4(CTLA-4)单克隆抗体抑制免疫检查点,彻底改变了晚期黑色素瘤患者的治疗方法,并且是许多其他癌症最有前途的治疗方法之一。CTLA-4 和 PD-1 抑制剂的使用,无论是单独使用还是联合使用,均已获得美国食品药品监督管理局(FDA)批准,用于治疗转移性黑色素瘤。这些新型免疫疗法的治疗会导致独特而不同的不良反应谱,这些不良反应主要与免疫系统的激活有关,因此是其作用机制的不良后果。CTLA-4 和/或 PD-1 抑制的不良反应最常见于皮肤、胃肠道、肝脏和内分泌系统,包括瘙痒、皮疹、恶心、腹泻和甲状腺疾病。在这篇综述中,作者描述了靶向 CTLA-4 和 PD-1 的检查点抑制剂的不良反应谱,这些抑制剂既可以单独使用,也可以联合使用,并旨在根据这些疗法的作用机制和这些免疫相关不良反应的管理,提供一些一般指南。