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免疫检查点抑制剂毒性的管理

[Management of Toxicities of Immune Checkpoint Inhibitors].

作者信息

Horio Yoshitsugu

机构信息

Dept. of Outpatient Services, Aichi Cancer Center Hospital.

出版信息

Gan To Kagaku Ryoho. 2017 Mar;44(3):185-190.

Abstract

Immune checkpoint inhibitors, including the anti-CTLA-4 antibody ipilimumab, the anti-PD-1 antibodies nivolumab and pembrolizumab, and the anti-PD-L1 antibody atezolizumab had produced long-lasting tumor responses in several malignancies. Immune-related Adverse Events(irAEs)which are different from adverse events of conventional chemotherapy and molecular targeted therapy, occur as a consequence of impaired self-tolerance from loss of T-cell inhibition. The main irAEs of immune checkpoint inhibitors include dermatological, gastrointestinal, pulmonary, hepatic, endocrine, renal toxicities. Every organ system can be potentially involved, but nivolumab, pembrolizumab and atezolizumab have a different toxicity profile with fewer high grade events compared with ipilimumab. In this article, we provide an approach to appropriate management for each class of irAEs.

摘要

免疫检查点抑制剂,包括抗CTLA-4抗体伊匹木单抗、抗PD-1抗体纳武单抗和派姆单抗,以及抗PD-L1抗体阿特珠单抗,已在多种恶性肿瘤中产生了持久的肿瘤反应。免疫相关不良事件(irAEs)与传统化疗和分子靶向治疗的不良事件不同,是由于T细胞抑制丧失导致自身耐受性受损而发生的。免疫检查点抑制剂的主要irAEs包括皮肤、胃肠道、肺部、肝脏、内分泌、肾脏毒性。每个器官系统都可能受累,但与伊匹木单抗相比,纳武单抗、派姆单抗和阿特珠单抗具有不同的毒性特征,高级别事件较少。在本文中,我们提供了一种针对各类irAEs的适当管理方法。

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