Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Clin Immunol. 2020 May;214:108395. doi: 10.1016/j.clim.2020.108395. Epub 2020 Mar 30.
Immune related adverse events (irAEs) have been observed with all checkpoint inhibitors and are very frequent. The evidences coming from experimental models of congenital or acquired deficiency of CTLA-4 or from PD-1 knock-out mice, provided all the informations to interpret the organ or systemic manifestations (endocrine, or systemic autoimmune chronic inflammatory diseases-ACIDs) observed in trials as well as in registries of cohorts treated with anti-CTLA-4 or anti-PD-1/PD-L1 inhibitors, or combination therapies. Finally the concern raised by cancers occurring in patients with autoimmune diseases (Systemic Lupus Erythematosus, Myositis, Rheumatoid Arthritis, Psoriatic Arthritis, Vasculitis, Scleroderma, Polymyalgia Rheumatica and others) and how to deal with immunotherapy was discussed. The biological knowledges acquired with the immunotherapy trials, have paved to way to better treat autoimmune diseases in patients developing cancer during the autoimmune illness. Immunotherapy without Autoimmunity is the unmet need within our reach in the future.
免疫相关不良事件（irAEs）已在所有检查点抑制剂中观察到，且非常常见。来自 CTLA-4 先天性或获得性缺陷的实验模型或 PD-1 敲除小鼠的证据，为解释在临床试验和抗 CTLA-4 或抗 PD-1/PD-L1 抑制剂或联合治疗中观察到的器官或全身表现（内分泌或全身性自身免疫性慢性炎症性疾病）提供了所有信息。最后，讨论了在患有自身免疫性疾病（红斑狼疮、肌炎、类风湿关节炎、银屑病关节炎、血管炎、硬皮病、多发性肌痛和其他疾病）的患者中发生癌症的问题，以及如何处理免疫疗法。免疫治疗试验获得的生物学知识，为在自身免疫性疾病期间发生癌症的患者更好地治疗自身免疫性疾病铺平了道路。未来，免疫治疗而不产生自身免疫是我们可以实现的未满足需求。
