Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Immunother Cancer. 2017 Nov 21;5(1):95. doi: 10.1186/s40425-017-0300-z.
Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs' therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy.
癌症免疫疗法改变了癌症的治疗方式。然而，随着免疫疗法的广泛应用，包括广泛使用的一类被称为免疫检查点抑制剂的药物，已经暴露出一组明确的与免疫相关的不良事件（irAEs）。这些不良事件中的许多是由相同的免疫机制引起的，这些机制负责药物的治疗效果，即阻断抑制免疫系统的抑制机制，防止身体组织受到不受控制的急性或慢性免疫反应的影响。皮肤、肠道、内分泌、肺部和肌肉骨骼的 irAEs 较为常见，而心血管、血液、肾脏、神经和眼科的 irAEs 则较少发生。大多数 irAEs 的严重程度为轻度至中度；然而，文献中也有严重的、偶尔危及生命的 irAEs 报告，并且治疗相关的死亡在高达 2%的患者中发生，具体取决于免疫检查点抑制剂的种类。与化疗引起的不良事件相比，免疫治疗相关的 irAEs 通常发病较晚，持续时间较长，有效的管理取决于早期识别和及时干预免疫抑制和/或免疫调节策略。目前迫切需要多学科指导，以反映如何识别、报告和管理特定器官毒性的广泛观点，直到有基于证据的数据为临床决策提供信息。癌症免疫治疗学会（SITC）成立了一个多学科毒性管理工作组，该工作组召开了为期一天的研讨会，制定了关于标准化 irAEs 管理的建议。在这里，我们提出了他们关于管理免疫检查点抑制剂治疗相关毒性的共识建议。
