Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Crit Care Med. 2020 Jan;48(1):10-21. doi: 10.1097/CCM.0000000000004087.
To describe the most common serious adverse effects and organ toxicities associated with emerging therapies for cancer that may necessitate admission to the ICU.
PubMed and Medline search of relevant articles in English on the management of adverse effects of immunotherapy for cancer.
Targeted therapies including tyrosine kinase inhibitors, monoclonal antibodies, checkpoint inhibitors, and immune effector cell therapy have improved the outcome and quality of life of patients with cancer. However, severe and life-threatening side effects can occur. These toxicities include infusion or hypersensitivity reactions, cytokine release syndrome, pulmonary, cardiac, renal, hepatic, and neurologic toxicities, hemophagocytic lymphohistiocytosis, opportunistic infections, and endocrinopathies. Cytokine release syndrome is the most common serious toxicity after administration of monoclonal antibodies and immune effector cell therapies. Most of the adverse events from immunotherapy results from an exaggerated T-cell response directed against normal tissue, resulting in the generation of high levels of proinflammatory cytokines. Toxicities from targeted therapies are usually secondary to "on target toxicities." Management is largely supportive and may include discontinuation of the specific agent, corticosteroids, and other immune suppressing agents for severe (grade 3 or 4) immune-related adverse events like neurotoxicity and pneumonitis.
The complexity of toxicities associated with modern targeted and immunotherapeutic agents for cancer require a multidisciplinary approach among ICU staff, oncologists, and organ specialists and adoption of standardized treatment protocols to ensure the best possible patient outcomes.
描述与癌症新兴治疗相关的最常见严重不良事件和器官毒性，这些不良事件可能需要患者入住重症监护病房（ICU）。
在 PubMed 和 Medline 上以英文搜索关于癌症免疫治疗不良反应管理的相关文章。
靶向治疗包括酪氨酸激酶抑制剂、单克隆抗体、检查点抑制剂和免疫效应细胞治疗，已经改善了癌症患者的预后和生活质量。然而，严重的危及生命的副作用可能会发生。这些毒性包括输注或过敏反应、细胞因子释放综合征、肺、心脏、肾脏、肝脏和神经系统毒性、噬血细胞性淋巴组织细胞增生症、机会性感染和内分泌疾病。细胞因子释放综合征是单克隆抗体和免疫效应细胞治疗后最常见的严重毒性。免疫治疗的大多数不良事件是由于针对正常组织的 T 细胞反应过度引起的，导致促炎细胞因子水平升高。靶向治疗的毒性通常是“针对目标的毒性”的结果。治疗主要是支持性的，可能包括停用特定药物、皮质类固醇和其他免疫抑制剂，以治疗严重的（3 级或 4 级）免疫相关不良事件，如神经毒性和肺炎。
癌症现代靶向和免疫治疗药物相关毒性的复杂性需要 ICU 工作人员、肿瘤学家和器官专家之间采取多学科方法，并采用标准化治疗方案，以确保患者获得最佳结果。
