Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pharmacology and Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Lancet Respir Med. 2018 Jun;6(6):472-478. doi: 10.1016/S2213-2600(18)30172-3.
Pulmonary toxicity of cancer immunotherapies has emerged as an important clinical event that requires prompt identification and management. Although often referred to as pneumonitis, pulmonary toxicity associated with immunotherapy covers a broad and overlapping spectrum of pulmonary manifestations, and, once suspected, the range of differential diagnoses of infectious and neoplastic processes might make the diagnostic process challenging for physicians. Optimal care can require multidisciplinary effort by pulmonologists, medical oncologists, and radiologists, and awareness of the possibility of treatment-induced pulmonary toxicity by emergency department and primary care physicians. This Viewpoint gives an overview of the diagnosis and management of pulmonary toxicity arising from cancer immunotherapy, including widely used treatments, such as immune checkpoint inhibitors, and emerging therapies, such as chimeric antigen receptor T cells.
癌症免疫疗法的肺毒性已成为一个重要的临床事件,需要及时识别和管理。虽然通常被称为肺炎,但与免疫疗法相关的肺毒性涵盖了广泛且重叠的肺部表现谱,一旦怀疑,感染和肿瘤过程的鉴别诊断范围可能使医生的诊断过程具有挑战性。最佳治疗可能需要肺病专家、肿瘤内科医生和放射科医生的多学科努力,并且急诊医生和初级保健医生应该意识到治疗引起的肺毒性的可能性。本观点概述了癌症免疫疗法引起的肺毒性的诊断和管理,包括广泛使用的治疗方法,如免疫检查点抑制剂,以及新兴的治疗方法,如嵌合抗原受体 T 细胞。