a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France.
b Service des maladies du sang, médecine interne, maladies infectieuses (MIIS) , Centre Hospitalier de Quimper Cornouaille , Quimper , France.
Expert Rev Anticancer Ther. 2018 Oct;18(10):981-989. doi: 10.1080/14737140.2018.1499468. Epub 2018 Jul 20.
Because of their efficacy against numerous cancers, immune-checkpoint inhibitors (ICIs), anti-cytotoxic T-lymphocyte antigen-4, and anti-programmed cell death monoclonal antibodies are being used ever more often in oncology. However, some patients were excluded from clinical trials because of their comorbidities despite their potentially higher cancer frequencies, as is the case for immunocompromised patients. Areas covered: We analyzed reported preclinical and clinical information and evaluated the risk/benefit ratio for four immunocompromised populations: people living with human immunodeficiency virus (PLHs), solid-organ transplant recipients, recipients of hematopoietic stem-cell allografts, and patients with autoimmune diseases. Expert commentary: Information available in the literature is fragmentary and scarce, making it difficult to evaluate the risk/benefit ratio. It can, nonetheless, be noted that ICI use in PLHs seems possible. For solid-organ transplant recipients, the risk for the graft seems elevated. For the other two populations, it is difficult to conclude at this time.
由于免疫检查点抑制剂(ICIs)、抗细胞毒性 T 淋巴细胞抗原 4 和抗程序性细胞死亡单克隆抗体在肿瘤学中的疗效显著,它们的使用越来越广泛。然而,一些患有合并症的患者尽管癌症发病率较高,却被排除在临床试验之外,免疫功能低下的患者就是这种情况。
我们分析了已报道的临床前和临床信息,并评估了四种免疫功能低下人群的风险/获益比:人类免疫缺陷病毒(PLH)感染者、实体器官移植受者、造血干细胞同种异体移植受者和自身免疫性疾病患者。
文献中提供的信息是零散和稀缺的,这使得评估风险/获益比变得困难。然而,可以注意到,ICI 在 PLH 中的使用似乎是可行的。对于实体器官移植受者,移植物的风险似乎增加了。对于其他两个群体,目前还难以得出结论。