Division of Rheumatology, Department of Internal medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Division of Rheumatology, Department of Internal medicine, Soonchunhyang university Seoul Hospital, Seoul, Korea.
Korean J Intern Med. 2019 Nov;34(6):1197-1209. doi: 10.3904/kjim.2019.060. Epub 2019 Apr 25.
Immune checkpoint inhibitors (ICIs) have revolutionized anticancer therapy due to their long-term clinical benefits and immune boosting mechanisms. However, despite their consistent therapeutic effects, the use of ICIs is associated with a spectrum of adverse events due to their autoimmune and auto-inflammatory actions. These adverse events can affect any organ system, including the endocrine, neurologic, gastrointestinal, cardiac, skin, pulmonary, and musculoskeletal systems. Of the immune-related adverse events (irAEs), rheumatic complications are common and appear to be distinct from irAEs in other organs in terms of variability of onset time, capacity for persistence, and relationship with pre-existing autoimmune rheumatologic diseases. In this article, we review the mechanisms of the anti-cancer effects of ICIs, the irAEs of immuno-oncology drugs, and the general recommendations for managing irAEs. In particular, we focus on rheumatologic irAEs and discuss their prevalence, clinical characteristics, and management.
免疫检查点抑制剂（ICIs）由于其长期的临床获益和免疫增强机制，彻底改变了癌症治疗方法。然而，尽管它们具有一致的治疗效果，但由于其自身免疫和自身炎症作用，ICI 的使用与一系列不良反应相关。这些不良反应可影响任何器官系统，包括内分泌、神经、胃肠道、心脏、皮肤、肺部和肌肉骨骼系统。在免疫相关不良反应（irAEs）中，风湿性并发症很常见，并且与其他器官的 irAEs 在发病时间、持续能力和与预先存在的自身免疫性风湿病的关系方面似乎有所不同。在本文中，我们回顾了 ICI 的抗癌作用、免疫肿瘤药物的 irAEs 以及管理 irAEs 的一般建议的机制。特别地，我们关注风湿性 irAEs，并讨论其患病率、临床特征和管理。
