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靶向抗肿瘤治疗和免疫治疗患者皮肤不良反应的临床管理:西班牙皮肤病学会和性病学会与西班牙肿瘤内科学会的国家共识声明。

Clinical management of cutaneous adverse events in patients on targeted anticancer therapies and immunotherapies: a national consensus statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology.

机构信息

Medical Oncology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba km 5.4, 28041, Madrid, Spain.

Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.

出版信息

Clin Transl Oncol. 2019 May;21(5):556-571. doi: 10.1007/s12094-018-1953-x. Epub 2018 Oct 3.

Abstract

Progress in the understanding of many tumors has enabled the development of new therapies, such as those targeted at specific molecules involved in cell growth (targeted therapies) or intended to modulate the immune system (immunotherapy). However, along with the clinical benefit provided by these new treatments, new adverse effects have also appeared. Dermatological toxicities such as papulopustular eruptions, xerosis, and pruritus are common with EGFR inhibitors. Other adverse effects have also been described with PDGFR, BCR-ABL, and MAPK tyrosine kinase inhibitors, antiangiogenic drugs, and inhibitors at immune checkpoints such as CTLA-4 and PD-1/PD-L1. Onset of these adverse effects often causes dose reductions and/or delays in administering the prescribed therapy, which can affect patient survival and quality of life. It is, therefore, important to prevent the occurrence of these adverse effects, or to treat unavoidable ones as soon as possible. This requires cooperation between medical oncologists and dermatologists. This article reviews the various dermatological toxicities associated with targeted therapies and immunotherapies, along with their diagnosis and therapeutic management.

摘要

许多肿瘤的研究进展使新疗法得以开发,例如针对参与细胞生长的特定分子的治疗方法(靶向治疗)或旨在调节免疫系统的治疗方法(免疫治疗)。然而,随着这些新治疗方法带来的临床益处,新的不良反应也出现了。表皮生长因子受体抑制剂会引起常见的皮肤毒性,如脓疱性皮疹、干燥和瘙痒。其他不良反应也已在 PDGFR、BCR-ABL 和 MAPK 酪氨酸激酶抑制剂、抗血管生成药物以及免疫检查点抑制剂(如 CTLA-4 和 PD-1/PD-L1)中描述过。这些不良反应的出现常常导致剂量减少和/或延迟给予规定的治疗,这会影响患者的生存和生活质量。因此,预防这些不良反应的发生,或尽快治疗不可避免的不良反应非常重要。这需要肿瘤内科医生和皮肤科医生之间的合作。本文回顾了与靶向治疗和免疫治疗相关的各种皮肤毒性及其诊断和治疗管理。

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