Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Bayview, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, MD, USA.
Curr Treat Options Oncol. 2018 Aug 13;19(9):46. doi: 10.1007/s11864-018-0562-9.
Immune checkpoint inhibitors have revolutionized the management of advanced NSCLC. With the intention of generating an anti-tumor immune response, ICIs can also lead to inflammatory side effects involving a wide variety of organs in the body, termed immune-related adverse events. Although no prospective clinical trial exists to guide recommendations for optimal and more specific immunosuppressive treatments rather than corticosteroids, further studies may lead to a more mechanistic-based approach towards these toxicities in the future. In relation to current practice, we recommend adherence to the recent published guidelines which emphasize the importance of early recognition and administration of temporary immunosuppressive therapy with corticosteroids in most cases, depending on the organ system involved, and the severity of toxicity. Recognition of these toxicities is increasingly important as the use of these agents expand within different indications for patients with lung cancers, and to other tumor types.
免疫检查点抑制剂彻底改变了晚期 NSCLC 的治疗方式。为了产生抗肿瘤免疫反应,ICI 还可能导致涉及全身多种器官的炎症副作用,称为免疫相关不良事件。尽管目前尚无前瞻性临床试验来指导最佳和更具体的免疫抑制治疗建议,而不是皮质类固醇,但未来的进一步研究可能会使我们对这些毒性有一个更基于机制的方法。就目前的实践而言,我们建议遵循最近发表的指南,这些指南强调了在大多数情况下(根据涉及的器官系统和毒性的严重程度),早期识别和使用皮质类固醇进行临时免疫抑制治疗的重要性。随着这些药物在不同肺癌患者的适应证中以及其他肿瘤类型中的应用不断扩大,识别这些毒性作用变得越来越重要。