Ellithi Moataz, Elnair Radowan, Chang Guy Vin, Abdallah Mohamed A
Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
Hematology and Oncology, University of Nebraska, Omaha, USA.
Cureus. 2020 Feb 10;12(2):e6935. doi: 10.7759/cureus.6935.
Immune checkpoint inhibitors (ICI) have revolutionized the treatment of cancer worldwide. Not long ago, before the introduction of ICIs, many cancers incurred a grave prognosis on patients due to the lack of effective therapies. For instance, patients with malignant melanoma survive longer and experience a better quality of life than ever before due to agents such as nivolumab and ipilimumab. Nevertheless, toxicities associated with the use of ICIs have been increasingly recognized in clinical trials as well as oncology practice. The widespread usage of ICIs and the expected addition of newer ICIs to the arsenal of medications to fight cancer raise awareness of the potential toxicities of these medications. Once these toxicities develop, immunosuppression with or without withholding immunotherapy is the standard of care. Because the long-term adverse effects of these toxicities and the impact of stopping therapy on survival are not well characterized, a joint decision by both the oncologist and the patient should be carried out if stopping therapy is being considered. Nevertheless, long-term data is necessary to guide such decisions. In this article, we will discuss common ICI's immune-related adverse events with a simplified approach to recognizing and managing these events.
免疫检查点抑制剂(ICI)彻底改变了全球癌症的治疗方式。不久前,在ICI引入之前,由于缺乏有效治疗方法,许多癌症患者预后严重。例如,由于纳武单抗和伊匹单抗等药物,恶性黑色素瘤患者的生存期比以往更长,生活质量也更高。然而,在临床试验以及肿瘤学实践中,与使用ICI相关的毒性越来越受到关注。ICI的广泛使用以及预计将有更多新型ICI加入抗癌药物库,提高了人们对这些药物潜在毒性的认识。一旦出现这些毒性,无论是否停止免疫治疗,进行免疫抑制都是标准治疗方法。由于这些毒性的长期不良反应以及停止治疗对生存的影响尚不明确,如果考虑停止治疗,肿瘤学家和患者应共同做出决定。然而,需要长期数据来指导此类决策。在本文中,我们将以简化的方法讨论常见的ICI免疫相关不良事件,以及识别和管理这些事件的方法。