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对免疫检查点抑制剂治疗相关毒性机制的认识不断深入。

Evolving insights into the mechanisms of toxicity associated with immune checkpoint inhibitor therapy.

作者信息

Mangan Brendan L, McAlister Renee K, Balko Justin M, Johnson Douglas B, Moslehi Javid J, Gibson Andrew, Phillips Elizabeth J

机构信息

Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.

Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.

出版信息

Br J Clin Pharmacol. 2020 Sep;86(9):1778-1789. doi: 10.1111/bcp.14433. Epub 2020 Jul 17.

Abstract

Immune checkpoint inhibitors have emerged as a revolutionary treatment option for patients with various types of malignancy. Although these agents afford a significant improvement in outcomes for melanoma and other previously untreatable malignancies, their novel mechanism of action may predispose patients to immune-related adverse effects (irAEs). In the tumour neoantigen environment, these irAEs are due to the activation of the immune system by the blockade of suppressive checkpoints, leading to increases in T-cell activation and proliferation. IrAEs have been reported in almost any organ and at any point in time, even months to years after discontinuation of therapy. Certain populations with distinct physiological changes, genetic risk factors, and specific antigen exposures may be more highly predisposed to develop irAEs. This review discusses the incidence and mechanisms of irAEs and the relationship between host factors and irAE occurrence.

摘要

免疫检查点抑制剂已成为各类恶性肿瘤患者的一种革命性治疗选择。尽管这些药物显著改善了黑色素瘤和其他先前无法治疗的恶性肿瘤的治疗效果,但其独特的作用机制可能使患者易发生免疫相关不良反应(irAE)。在肿瘤新抗原环境中,这些irAE是由于抑制性检查点的阻断激活了免疫系统,导致T细胞活化和增殖增加。几乎在任何器官、任何时间都有irAE的报道,甚至在治疗中断数月至数年之后。某些具有独特生理变化、遗传风险因素和特定抗原暴露的人群可能更易发生irAE。本文综述了irAE的发生率、机制以及宿主因素与irAE发生之间的关系。

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