罕见免疫相关不良事件的诊断与管理。
Diagnosis and Management of Rare Immune-Related Adverse Events.
机构信息
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Oncologist. 2020 Jan;25(1):6-14. doi: 10.1634/theoncologist.2019-0083. Epub 2019 Nov 6.
Oncologic treatment is being revolutionized by a burgeoning number of immune checkpoint inhibitors (ICPis). To date, seven ICPis have received Food and Drug Administration approval, targeting cytotoxic T-lymphocyte antigen, programmed cell death, or programmed cell death ligand. Adverse events associated with checkpoint inhibition have been described in the literature. Guidelines exist for the most common of these, but as the use of ICPis becomes more common, the number of patients presenting with rare events will increase. This article reviews the diagnosis and management of rare ocular, hematological, luminal gastrointestinal, and rheumatological toxicities arising from ICPi treatment. KEY POINTS: As the use of immune checkpoint inhibitors (ICPis) becomes more common, the number of rare immune-related adverse events (irAEs) will increase. A high level of suspicion is required to identify and treat these toxicities. Although it can be difficult to definitively attribute rare irAEs to ICPis, a temporal and mechanistic relationship and the absence of other etiologies should make the treating physician suspicious for a rare irAE. Certain rare irAEs, such as celiac disease, do not require treatment with glucocorticoids. Thus, differentiating this irAE from other gastrointestinal irAEs has important implications for treatment.
肿瘤治疗正在被大量涌现的免疫检查点抑制剂 (ICPis) 所改变。迄今为止,已有七种 ICPi 获得了美国食品和药物管理局的批准,针对细胞毒性 T 淋巴细胞抗原、程序性细胞死亡或程序性细胞死亡配体。文献中已经描述了与检查点抑制相关的不良反应。对于这些最常见的不良反应,已经存在指南,但随着 ICPi 的使用变得更加普遍,出现罕见事件的患者数量将会增加。本文综述了由 ICPi 治疗引起的罕见眼部、血液学、腔道胃肠道和风湿学毒性的诊断和管理。
关键点
随着免疫检查点抑制剂 (ICPis) 的使用越来越普遍,罕见免疫相关不良事件 (irAEs) 的数量将会增加。需要高度怀疑才能识别和治疗这些毒性。
虽然很难将罕见的 irAEs 明确归因于 ICPis,但暂时和机制关系以及缺乏其他病因应使治疗医生对罕见的 irAE 产生怀疑。
某些罕见的 irAEs,如乳糜泻,不需要用糖皮质激素治疗。因此,将这种 irAE 与其他胃肠道 irAEs 区分开来对治疗具有重要意义。