Sosa Aaron, Lopez Cadena Esther, Simon Olive Cristina, Karachaliou Niki, Rosell Rafael
Department of Medical Oncology, Hospital Universitari Sagrat Cor, Viladomat 288, Barcelona 08029, Spain.
Department of Pneumonology, Hospital Universitari Sagrat Cor, Barcelona, Spain.
Ther Adv Med Oncol. 2018 Mar 30;10:1758835918764628. doi: 10.1177/1758835918764628. eCollection 2018.
Immunotherapy through checkpoint inhibitors is now standard practice for a growing number of cancer types, supported by overall improvement of clinical outcomes and better tolerance. One anti-CTLA-4 antibody (ipilimumab), two anti-PD-1 antibodies (pembrolizumab and nivolumab) and three anti-PD-L1 antibodies (atezolizumab, avelumab and durvalumab) have been approved for clear benefits across diverse trials. Adverse events of an immune nature associated with these agents frequently affect the skin, colon, endocrine glands, lungs and liver. Most of these effects are mild and can be managed through transient immunosuppression with corticosteroids, but high-grade events often require hospitalization and specialized treatment. However, since immunotherapy is recent, physicians with clinical experience in the diagnosis and management of immune toxicities are frequently those who actively participated in trials, but many practicing oncologists are still not familiarized with the assessment of these events. This review focuses on the incidence, diagnostic assessment and recommended management of the most relevant immune-related adverse events.
通过检查点抑制剂进行免疫治疗现已成为越来越多癌症类型的标准治疗方法，这得益于临床结果的全面改善和更好的耐受性。一种抗CTLA-4抗体（伊匹单抗）、两种抗PD-1抗体（帕博利珠单抗和纳武利尤单抗）以及三种抗PD-L1抗体（阿特珠单抗、阿维鲁单抗和度伐利尤单抗）已在各种试验中被证明具有明显益处并获得批准。与这些药物相关的免疫性不良事件经常影响皮肤、结肠、内分泌腺、肺和肝脏。这些影响大多较轻，可通过使用皮质类固醇进行短暂免疫抑制来处理，但严重事件通常需要住院和专门治疗。然而，由于免疫治疗是最近才出现的，具有免疫毒性诊断和管理临床经验的医生往往是那些积极参与试验的人，但许多执业肿瘤学家仍不熟悉这些事件的评估。本综述重点关注最相关的免疫相关不良事件的发生率、诊断评估和推荐的管理方法。
