Department of Urology, Weill Cornell Medicine, New York, New York.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Cancer. 2019 Oct 15;125(20):3506-3513. doi: 10.1002/cncr.32326. Epub 2019 Jul 18.
Newly developed immune checkpoint inhibitors (ICIs) demonstrate impressive clinical activity. However, they can also cause life-threatening side effects. The efficacy and toxicity associated with ICIs both derive from unregulated, enhanced immune activation. Health care providers have been hesitant to prescribe these medications to patients who have preexisting autoimmune disease (AD) because of concerns that this may exacerbate their underlying immune condition. These patients have also been excluded from ongoing ICI clinical trials. However, new data suggest that the potential benefits of ICI treatment may outweigh the potential risks for this patient group as long as physicians also provide sufficient monitoring for AD exacerbations or other side effects. Therefore, it may be appropriate to include patients with advanced malignancies and preexisting AD in ICI clinical trials when no other effective cancer treatment options exist. Overall, physicians should avoid excluding patients from ICI therapy unnecessarily when the potential benefits outweigh the potential risks.
新开发的免疫检查点抑制剂 (ICI) 显示出令人印象深刻的临床活性。然而，它们也可能导致危及生命的副作用。ICI 相关的疗效和毒性都源于不受调节、增强的免疫激活。由于担心这可能会使潜在的免疫状况恶化，医疗保健提供者一直不愿意给患有自身免疫性疾病 (AD) 的患者开这些药物。这些患者也被排除在正在进行的 ICI 临床试验之外。然而，新数据表明，只要医生充分监测 AD 恶化或其他副作用，ICI 治疗的潜在益处可能超过这组患者的潜在风险。因此，在没有其他有效癌症治疗选择的情况下，当潜在益处超过潜在风险时，可能适合将患有晚期恶性肿瘤和预先存在的 AD 的患者纳入 ICI 临床试验。总的来说，当潜在益处超过潜在风险时，医生不应该不必要地将患者排除在 ICI 治疗之外。
