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美国食品和药物管理局不良事件报告系统中的免疫检查点抑制剂严重皮肤毒性。

Serious Cutaneous Toxicities with Immune Checkpoint Inhibitors in the U.S. Food and Drug Administration Adverse Event Reporting System.

机构信息

Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

出版信息

Oncologist. 2019 Nov;24(11):e1228-e1231. doi: 10.1634/theoncologist.2019-0250. Epub 2019 Aug 6.

Abstract

Cutaneous toxicities frequently occurred with immune checkpoint inhibitors (ICIs), although clinical and pharmacological features are incompletely characterized. The U.S. Food and Drug Administration Adverse Event Reporting System was queried to describe ICI-related cutaneous toxicities, focusing on severe cutaneous adverse reactions (SCARs): Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. As compared with other anticancer drugs, a higher proportion of death (11.3% vs. 8.7%) and serious reports (42.7% vs. 34.6%) emerged for ICIs ( < .05). A higher frequency of coreported allopurinol and antiepileptics was recorded among 2,525 total SCARs (17% vs. 10%, ICIs and anticancer agents, respectively; < .05). Mean times to onset were 47, 48, and 40 days (SJS, TEN, and DRESS, respectively), with comparable mean latency between monotherapy and combination regimens (41 days). This immune-related pattern advocates for long-lasting monitoring by oncologists and dermatologists.

摘要

免疫检查点抑制剂 (ICIs) 常引起皮肤毒性,但临床和药理学特征尚不完全明确。本研究通过查询美国食品和药物管理局不良事件报告系统,描述了 ICI 相关皮肤毒性,重点关注严重皮肤不良反应 (SCARs):史蒂文斯-约翰逊综合征 (SJS)、中毒性表皮坏死松解症 (TEN) 和药物反应伴嗜酸性粒细胞增多和全身症状 (DRESS) 综合征。与其他抗癌药物相比,ICI 导致的死亡 (11.3% vs. 8.7%) 和严重报告 (42.7% vs. 34.6%) 比例更高 ( <.05)。在 2525 例总 SJS 中,报告的别嘌醇和抗癫痫药的频率更高 (17% vs. 10%,ICI 和抗癌药物; <.05)。发病中位时间分别为 47、48 和 40 天 (SJS、TEN 和 DRESS),单药与联合方案之间的潜伏期相当 (41 天)。这种免疫相关模式提示肿瘤学家和皮肤科医生进行长期监测。

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